Provider Demographics
NPI:1669840658
Name:STEWART, BRIENNE
Entity Type:Individual
Prefix:
First Name:BRIENNE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 132ND ST SE
Mailing Address - Street 2:STE C
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5309
Mailing Address - Country:US
Mailing Address - Phone:425-338-1555
Mailing Address - Fax:425-338-0765
Practice Address - Street 1:1700 132ND ST SE
Practice Address - Street 2:STE C
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5309
Practice Address - Country:US
Practice Address - Phone:425-338-1555
Practice Address - Fax:425-338-0765
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60582672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist