Provider Demographics
NPI:1780836981
Name:HUGHBANKS, BRENDA MICHELE (MA 60040625)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MICHELE
Last Name:HUGHBANKS
Suffix:
Gender:F
Credentials:MA 60040625
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 A GARDEN SPOT RD.
Mailing Address - Street 2:PO BOX 442
Mailing Address - City:LOON LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99148
Mailing Address - Country:US
Mailing Address - Phone:509-233-8660
Mailing Address - Fax:
Practice Address - Street 1:4130 A GARDEN SPOT RD.
Practice Address - Street 2:
Practice Address - City:LOON LAKE
Practice Address - State:WA
Practice Address - Zip Code:99148
Practice Address - Country:US
Practice Address - Phone:509-233-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60040625173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist