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Individual

MARALYSSA ANGELIQUE BANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
325 9TH AVE, SEATTLE, WA 98104-2420
(206) 744-3000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60400820
WA
208M00000X
Hospitalist Physician
Primary
MD60400820
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1922337021
WA
01
8928081
MEDICARE PIN
WA
Enumeration date
12/18/2009
Last updated
11/02/2017
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