Provider Demographics
NPI:1427492255
Name:BREANNA COPELAND
Entity type:Organization
Organization Name:BREANNA COPELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-992-5564
Mailing Address - Street 1:3901 2ND AVE NE APT 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6842
Mailing Address - Country:US
Mailing Address - Phone:206-992-5564
Mailing Address - Fax:
Practice Address - Street 1:11421 31ST DR SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5273
Practice Address - Country:US
Practice Address - Phone:425-379-2975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA163WH0200X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA163WH00000XOtherPRIVATE LICENSED NURSE TASONOMY CODE