Provider Demographics
NPI:1477649812
Name:DENNIS, BRIANNE LEIGH (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:LEIGH
Last Name:DENNIS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:LEIGH
Other - Last Name:GIANCOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9539 49TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2627
Mailing Address - Country:US
Mailing Address - Phone:813-205-0681
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:813-205-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN216557163W00000X
WAAP60732494363LP0200X
TNAPN21658363LP0200X
OR202000504NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766845700Medicaid