Provider Demographics
NPI:1326516600
Name:SMITH, BRANDON E (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18515 40TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2802
Mailing Address - Country:US
Mailing Address - Phone:206-498-9993
Mailing Address - Fax:
Practice Address - Street 1:22850 NE 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7275
Practice Address - Country:US
Practice Address - Phone:206-498-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60909306363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care