Provider Demographics
NPI:1316016579
Name:BRAIN, SUSAN POWERS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:POWERS
Last Name:BRAIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 14TH AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4182
Mailing Address - Country:US
Mailing Address - Phone:509-547-9521
Mailing Address - Fax:509-547-5983
Practice Address - Street 1:1200 N 14TH AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4182
Practice Address - Country:US
Practice Address - Phone:509-547-9521
Practice Address - Fax:509-547-5983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9606419Medicaid
WA9606419Medicaid