Provider Demographics
NPI:1932631157
Name:LASSEN, BRANDEN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:
Last Name:LASSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 WALNUT HILL LN STE 615
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4424
Mailing Address - Country:US
Mailing Address - Phone:214-345-8393
Mailing Address - Fax:214-345-8409
Practice Address - Street 1:8220 WALNUT HILL LN STE 615
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4424
Practice Address - Country:US
Practice Address - Phone:214-345-8393
Practice Address - Fax:214-345-8409
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA11267363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant