Healthcare Provider Details

I. General information

NPI: 1053561670
Provider Name (Legal Business Name): BRENDA KAY SUTHERLAND LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 SW 166TH ST
BURIEN WA
98166-3438
US

IV. Provider business mailing address

600 1ST AVE SUITE 231
SEATTLE WA
98104-2216
US

V. Phone/Fax

Practice location:
  • Phone: 206-384-3368
  • Fax:
Mailing address:
  • Phone: 206-384-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN60115113
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00019884
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: