Healthcare Provider Details

I. General information

NPI: 1619536034
Provider Name (Legal Business Name): MARIA BRNJIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N 90TH ST
SEATTLE WA
98103-4016
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-5770
  • Fax: 206-973-8768
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-262-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60956630
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN60954860
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60956630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: