Healthcare Provider Details

I. General information

NPI: 1366644478
Provider Name (Legal Business Name): JACQUELINE PANKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 3RD AVE NE
SEATTLE WA
98115-2062
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-2222
  • Fax: 206-720-7476
Mailing address:
  • Phone: 206-860-5414
  • Fax: 206-720-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60932004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: