Provider Demographics
NPI:1154860344
Name:HANKS, ELAINE EVELYN ERVIN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:EVELYN ERVIN
Last Name:HANKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4729
Mailing Address - Country:US
Mailing Address - Phone:503-585-6388
Mailing Address - Fax:503-585-0669
Practice Address - Street 1:435 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4729
Practice Address - Country:US
Practice Address - Phone:503-585-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201700971NP PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner