Provider Demographics
NPI:1649727249
Name:WADSWORTH, BRETT LEE (JD, MSN, ARNP, PMHNP)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:LEE
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:JD, MSN, ARNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 226TH PL SE STE 203
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8969
Mailing Address - Country:US
Mailing Address - Phone:425-222-1000
Mailing Address - Fax:425-651-2973
Practice Address - Street 1:6520 226TH PL SE STE 203
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8969
Practice Address - Country:US
Practice Address - Phone:425-222-1000
Practice Address - Fax:425-651-2973
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9706363LP0808X
WAAP 60720812363LP0808X, 363LP0808X
NH075188-23363LP0808X
COAPN.0992842-NP363LP0808X
PASP017417363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13926671Medicaid