Individual
MS. JACQUELYN LOU BANASIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MN ARNP
Contact information
Practice address
103 E SPOKANE FALLS BLVD, NURS 447, SPOKANE, WA 99202
(509) 324-7269
(509) 324-7341
Mailing address
PO BOX 1495, NURS 447, SPOKANE, WA 99210-1495
(509) 324-7269
(509) 324-7341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AP30003996
WA
363LF0000X
Family Nurse Practitioner
Primary
AP30003996
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9623026
—
WA
Enumeration date
09/16/2005
Last updated
05/22/2018
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