Provider Demographics
NPI:1861647307
Name:BANKE, MARIANNE MUNCH (LAC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:MUNCH
Last Name:BANKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:MUNCH
Other - Last Name:KROKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2839 NE 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4653
Mailing Address - Country:US
Mailing Address - Phone:503-287-4066
Mailing Address - Fax:
Practice Address - Street 1:1535 NE 41ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1807
Practice Address - Country:US
Practice Address - Phone:503-282-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01213171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist