Provider Demographics
NPI:1275266496
Name:BRUSH, AMELIA ROSE
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ROSE
Last Name:BRUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ROSE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5580 NORDIC WAY
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-5104
Mailing Address - Country:US
Mailing Address - Phone:360-384-1511
Mailing Address - Fax:360-384-5758
Practice Address - Street 1:5580 NORDIC WAY
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-5104
Practice Address - Country:US
Practice Address - Phone:360-384-1511
Practice Address - Fax:360-384-5758
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WAPA61344002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant