Provider Demographics
NPI:1982631149
Name:KEIRNAN, BRENDA JILL (RNFA CNOR)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JILL
Last Name:KEIRNAN
Suffix:
Gender:F
Credentials:RNFA CNOR
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 821350
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0030
Mailing Address - Country:US
Mailing Address - Phone:360-567-3287
Mailing Address - Fax:360-666-0466
Practice Address - Street 1:400 MOTHER JOSEPH PLACE
Practice Address - Street 2:SOUTHWEST WASHINGTON MEDICAL CENTER
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98668
Practice Address - Country:US
Practice Address - Phone:360-806-0316
Practice Address - Fax:360-835-0478
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00096524163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276338Medicaid
WA9642448Medicaid