Healthcare Provider Details

I. General information

NPI: 1982697652
Provider Name (Legal Business Name): PAULA BRENTLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 05/02/2020
Certification Date: 05/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 MILITARY RD S STE 200
TUKWILA WA
98168-3001
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 206-439-3289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00021701
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: