Basic Information
| Provider Information | |||||||||
| NPI: | 1497745558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2512 WHEATON WAY STE A | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607825700 | ||||||||
| FaxNumber: | 3607825899 | ||||||||
| Practice Location | |||||||||
| Address1: | 2512 WHEATON WAY STE A | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607825700 | ||||||||
| FaxNumber: | 3607825899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 200650167NP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LC0200X | 0024164063 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | 363LF0000X | AP60541946 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2008837 | 05 | WA | MEDICAID | 278574 | 05 | OR | MEDICAID |