MEDICARE: BRENNA CHASE BSN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	RN60427940	WA

General Provider Information

NPI Number	:	1710499322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA CHASE BSN RN

Provider Business Mailing Address
First Line	:	411 N 63RD ST APT 303
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 34TH AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3240
Country	:	US
Telephone Number	:	206-252-1920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2017
Last Update Date	:	11/04/2017

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