Provider Demographics
NPI:1326295643
Name:WILLBANKS, ELAINE KAREN (RN)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:KAREN
Last Name:WILLBANKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14314 SW ALLEN BLVD
Mailing Address - Street 2:313
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4403
Mailing Address - Country:US
Mailing Address - Phone:503-349-2401
Mailing Address - Fax:
Practice Address - Street 1:14314 SW ALLEN BLVD
Practice Address - Street 2:313
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4403
Practice Address - Country:US
Practice Address - Phone:503-349-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095000623RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR611278OtherDHS MFCU