Healthcare Provider Details

I. General information

NPI: 1497745558
Provider Name (Legal Business Name): BRENDA LEE ABRAHAM N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 WHEATON WAY STE A
BREMERTON WA
98310-3303
US

IV. Provider business mailing address

2512 WHEATON WAY STE A
BREMERTON WA
98310-3303
US

V. Phone/Fax

Practice location:
  • Phone: 360-782-5700
  • Fax: 360-782-5899
Mailing address:
  • Phone: 360-782-5700
  • Fax: 360-782-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200650167NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0024164063
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60541946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: