Provider Demographics
NPI:1225866924
Name:GREEN, BRANDON (RN)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26104 201ST PL SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6121
Mailing Address - Country:US
Mailing Address - Phone:206-371-1006
Mailing Address - Fax:
Practice Address - Street 1:26104 201ST PL SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-6121
Practice Address - Country:US
Practice Address - Phone:206-371-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60389814163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy