Provider Demographics
NPI:1811357445
Name:BRADY, KRISULA MARIA (RN-BSN)
Entity type:Individual
Prefix:MRS
First Name:KRISULA
Middle Name:MARIA
Last Name:BRADY
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 153RD ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8851
Mailing Address - Country:US
Mailing Address - Phone:253-678-8110
Mailing Address - Fax:
Practice Address - Street 1:1320 153RD ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8851
Practice Address - Country:US
Practice Address - Phone:253-678-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60270102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist