Provider Demographics
NPI:1982339289
Name:O'DONAGHUE, BRIANNA LOUISE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:LOUISE
Last Name:O'DONAGHUE
Suffix:
Gender:F
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 1:7120 WOODLAWN AVE NE APT 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-1430
Mailing Address - Country:US
Mailing Address - Phone:585-766-3787
Mailing Address - Fax:
Practice Address - Street 1:4201 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2215
Practice Address - Country:US
Practice Address - Phone:425-382-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.PA.61363922363AM0700X, 363AM0700X
CAPA61710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical