Provider Demographics
NPI:1821869009
Name:BANKS, SANDRA KAY (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:BANKS
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 1:11882 SW 72ND AVE APT 513
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6086
Mailing Address - Country:US
Mailing Address - Phone:480-416-4153
Mailing Address - Fax:
Practice Address - Street 1:11882 SW 72ND AVE APT 513
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6086
Practice Address - Country:US
Practice Address - Phone:480-416-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10007242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse