Provider Demographics
NPI:1437895158
Name:BROUSE, KENDRA (RN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BROUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2539
Mailing Address - Country:US
Mailing Address - Phone:425-903-6631
Mailing Address - Fax:
Practice Address - Street 1:1141 PEAR TREE LN STE 100
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6485
Practice Address - Country:US
Practice Address - Phone:707-254-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4716806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse