Provider Demographics
NPI:1386910628
Name:BANKS, DEBORAH LYNN (LMP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNN
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W EVERGREEN BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3100
Mailing Address - Country:US
Mailing Address - Phone:360-639-3863
Mailing Address - Fax:360-693-6894
Practice Address - Street 1:210 W EVERGREEN BLVD
Practice Address - Street 2:STE 500
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3100
Practice Address - Country:US
Practice Address - Phone:360-639-3863
Practice Address - Fax:360-693-6894
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006985171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor