=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669521266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANNE M. BRABANSKI M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 S MAIN ST BLDG. A
-----------------------------------------------------
City | COUPEVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98239-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-678-1423
-----------------------------------------------------
Fax | 360-678-1769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 298
-----------------------------------------------------
City | COUPEVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98239-0298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-678-1423
-----------------------------------------------------
Fax | 360-678-1769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | CD00002369
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------