Provider Demographics
NPI:1679028039
Name:TURNBULL, BRINA MACKENZIE (PA)
Entity Type:Individual
Prefix:
First Name:BRINA
Middle Name:MACKENZIE
Last Name:TURNBULL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRINA
Other - Middle Name:MACKENZIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5901 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3120
Mailing Address - Country:US
Mailing Address - Phone:253-572-2842
Mailing Address - Fax:
Practice Address - Street 1:1500 N WARNER ST
Practice Address - Street 2:#1035
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98416
Practice Address - Country:US
Practice Address - Phone:253-879-1555
Practice Address - Fax:253-879-3766
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1134215363A00000X
WAPA60694991363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant