Healthcare Provider Details

I. General information

NPI: 1255806345
Provider Name (Legal Business Name): DONNA JEAN BRONDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 10TH ST
EVERETT WA
98201-1413
US

IV. Provider business mailing address

4130 138TH ST SE
MILL CREEK WA
98012-8989
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-4802
  • Fax:
Mailing address:
  • Phone: 425-225-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00169040
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: