Provider Demographics
NPI:1699305201
Name:SOWLE, BRADEN
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:SOWLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 100TH LN NE UNIT K150
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8827
Mailing Address - Country:US
Mailing Address - Phone:714-553-3226
Mailing Address - Fax:
Practice Address - Street 1:12603 100TH LN NE UNIT K150
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8827
Practice Address - Country:US
Practice Address - Phone:714-553-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist