Provider Demographics
NPI:1497745558
Name:ABRAHAM, BRENDA LEE (NP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 WHEATON WAY STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3303
Mailing Address - Country:US
Mailing Address - Phone:360-782-5700
Mailing Address - Fax:360-782-5899
Practice Address - Street 1:2512 WHEATON WAY STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-782-5700
Practice Address - Fax:360-782-5899
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650167NP363L00000X
VA0024164063363LC0200X
WAAP60541946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008837Medicaid
OR278574Medicaid
OR278574Medicaid
ORP01227254Medicare PIN
WA1497745558Medicaid
OR171643Medicare PIN
OR171646Medicare PIN