Basic Information
| Provider Information | |||||||||
| NPI: | 1003287749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANTLEY-DALGLISH | ||||||||
| FirstName: | ARIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1608 S J ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532747501 | ||||||||
| FaxNumber: | 2532747991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1608 S J ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532747501 | ||||||||
| FaxNumber: | 2532747991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2015 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201407145RN | OR | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN61088584 | WA | N | Nursing Service Providers | Registered Nurse | 367A00000X | 201606806NP-PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | AP61088603 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 500713679 | 05 | OR | MEDICAID | 2162681 | 05 | WA | MEDICAID |