Healthcare Provider Details

I. General information

NPI: 1700158326
Provider Name (Legal Business Name): BRANDON KEITH BIANCHINI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 07/10/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 33RD ST STE 100
VANCOUVER WA
98663
US

IV. Provider business mailing address

100 E 33RD ST STE 100
VANCOUVER WA
98663-2776
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7550
  • Fax: 360-514-7553
Mailing address:
  • Phone: 360-514-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61031683
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: