Individual
AMANDA BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 SW 16TH ST, CHEHALIS, WA 98532-3809
(360) 807-7200
Mailing address
310 SW 16TH ST, CHEHALIS, WA 98532-3809
(360) 807-7200
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN60094781
WA
Other
Enumeration date
02/07/2019
Last updated
02/07/2019
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