Individual
JANETTE J BANASIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
762296
Contact information
Practice address
422 HEFFLEY ST S, MONMOUTH, OR 97361-9728
(503) 983-8077
Mailing address
422 HEFFLEY ST S, MONMOUTH, OR 97361-9728
(503) 983-8077
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
762296
OR
Other
Enumeration date
02/08/2016
Last updated
02/08/2016
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