Healthcare Provider Details

I. General information

NPI: 1164998563
Provider Name (Legal Business Name): SHELDON ROBERT BRASEL JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S PEARL ST
TACOMA WA
98465-2117
US

IV. Provider business mailing address

815 S PEARL ST
TACOMA WA
98465-2117
US

V. Phone/Fax

Practice location:
  • Phone: 253-571-2600
  • Fax:
Mailing address:
  • Phone: 253-571-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN60787133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: