Provider Demographics
NPI:1639339708
Name:LIU, BRANDON M (ARNP, FA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:LIU
Suffix:
Gender:M
Credentials:ARNP, FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14064
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-0064
Mailing Address - Country:US
Mailing Address - Phone:425-283-8895
Mailing Address - Fax:877-631-3356
Practice Address - Street 1:611 MAYNARD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:425-283-8895
Practice Address - Fax:877-631-3356
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00151462163W00000X
WAAP60208496363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639339708Medicaid