Provider Demographics
NPI:1598292120
Name:ANDERSEN, BRADEN CARL (DNP, MBA, ARNP)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:CARL
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:DNP, MBA, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 SE 284TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3924
Mailing Address - Country:US
Mailing Address - Phone:253-217-0609
Mailing Address - Fax:253-600-2270
Practice Address - Street 1:19410 HIGHWAY 99 STE A-147
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5102
Practice Address - Country:US
Practice Address - Phone:253-217-0609
Practice Address - Fax:253-600-2270
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60750107363LA2100X, 363LF0000X, 207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner