Provider Demographics
NPI:1356976799
Name:PANKONIN, LYNN ADELE
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ADELE
Last Name:PANKONIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23201 W CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9744
Mailing Address - Country:US
Mailing Address - Phone:509-220-9224
Mailing Address - Fax:
Practice Address - Street 1:23201 W CHARLES RD
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9744
Practice Address - Country:US
Practice Address - Phone:509-220-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant