Provider Demographics
NPI:1396931101
Name:BRANDT, KAREN LEE (LMP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 12TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1428
Mailing Address - Country:US
Mailing Address - Phone:206-226-1759
Mailing Address - Fax:
Practice Address - Street 1:14439 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1423
Practice Address - Country:US
Practice Address - Phone:206-226-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist