MEDICARE: BRENDA MICHELE HUGHBANKS MA 60040625

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173C00000X	Reflexologist	MA 60040625	WA

General Provider Information

NPI Number	:	1780836981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MICHELE HUGHBANKS MA 60040625

Provider Business Mailing Address
First Line	:	4130 A GARDEN SPOT RD.
Second Line	:	PO BOX 442
City	:	LOON LAKE
State	:	WA
Zip	:	99148
Country	:	US
Telephone Number	:	509-233-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 A GARDEN SPOT RD.
Second Line	:
City	:	LOON LAKE
State	:	WA
Zip	:	99148
Country	:	US
Telephone Number	:	509-233-8660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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