Provider Demographics
NPI:1780246835
Name:STANKOVIC, PANE (RN)
Entity type:Individual
Prefix:
First Name:PANE
Middle Name:
Last Name:STANKOVIC
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6782
Mailing Address - Country:US
Mailing Address - Phone:509-554-1585
Mailing Address - Fax:
Practice Address - Street 1:3140 IRIS ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-6782
Practice Address - Country:US
Practice Address - Phone:509-554-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00172692163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse