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General NPI Number Information
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NPI Number | 1023832292
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Entity Type | Individual
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Provider Name | TAYLEE JEAN BREVICK
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 8018 178TH ST NW
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City | STANWOOD
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State | WA
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Zip | 98292-6746
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Country | US
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Telephone | 360-502-5486
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Fax |
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Provider Business Mailing Address
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Address Line | 3227 256TH ST NW
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City | STANWOOD
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State | WA
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Zip | 98292-9265
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Country | US
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Telephone | 360-502-5486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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