Healthcare Provider Details

I. General information

NPI: 1427492255
Provider Name (Legal Business Name): BREANNA COPELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11421 31ST DR SE
EVERETT WA
98208-5273
US

IV. Provider business mailing address

3901 2ND AVE NE APT 202
SEATTLE WA
98105-6842
US

V. Phone/Fax

Practice location:
  • Phone: 425-379-2975
  • Fax:
Mailing address:
  • Phone: 206-992-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number163WH0200X
License Number StateWA

VIII. Authorized Official

Name: BREANNA COPELAND
Title or Position: RN
Credential:
Phone: 206-992-5564