Healthcare Provider Details

I. General information

NPI: 1629058748
Provider Name (Legal Business Name): BRANDI LEA IRWIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 164TH STREET SE SUITE 100
MILL CREEK WA
98012
US

IV. Provider business mailing address

805 164TH STREET SE SUITE 100
MILL CREEK WA
98012
US

V. Phone/Fax

Practice location:
  • Phone: 425-354-4296
  • Fax: 425-332-3495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-7558
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP00002348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: