Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 200650167NP | OR |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024164063 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60541946 | WA |
NPI | 1497745558 |
---|---|
Provider Name | Ms. Brenda Lee Abraham |
First Address | Bremerton, WA 98310-3303 |
Second Address | Bremerton, WA 98310-3303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2008837 | (05) | WA |
278574 | (05) | OR |
P04259 | (02) |