Provider Demographics
NPI:1881077303
Name:BANKS, YVETTE MARIE (LMP)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARIE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 NE 112TH AVE APT D202
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5403
Mailing Address - Country:US
Mailing Address - Phone:360-869-6551
Mailing Address - Fax:
Practice Address - Street 1:516 SE CHKALOV DR STE 49
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5277
Practice Address - Country:US
Practice Address - Phone:360-869-6551
Practice Address - Fax:503-564-1953
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60417281225700000X
OR17785225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist