Provider Demographics
NPI:1164065355
Name:BRUSH, MINA LEE
Entity Type:Individual
Prefix:MRS
First Name:MINA
Middle Name:LEE
Last Name:BRUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3166
Mailing Address - Country:US
Mailing Address - Phone:253-381-7619
Mailing Address - Fax:
Practice Address - Street 1:7917 53RD AVE W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3166
Practice Address - Country:US
Practice Address - Phone:253-381-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider