Provider Demographics
NPI:1578294294
Name:WESTON, BRANDIE (CNA)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:WESTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25512 139TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6608
Mailing Address - Country:US
Mailing Address - Phone:206-678-6054
Mailing Address - Fax:
Practice Address - Street 1:25512 139TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-6608
Practice Address - Country:US
Practice Address - Phone:206-678-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA606821763747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider