Provider Demographics
NPI:1760664486
Name:BRANDT, ANN KATHRYN (LMP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:KATHRYN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 72ND ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443-2722
Mailing Address - Country:US
Mailing Address - Phone:253-537-8181
Mailing Address - Fax:253-537-8181
Practice Address - Street 1:5216 72ND ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98443-2722
Practice Address - Country:US
Practice Address - Phone:253-537-8181
Practice Address - Fax:253-537-8181
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist