Provider Demographics
NPI:1902276116
Name:TESTA, BRANDON (ND)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:TESTA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18208 66TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-7949
Mailing Address - Country:US
Mailing Address - Phone:425-814-2045
Mailing Address - Fax:425-814-2783
Practice Address - Street 1:18208 66TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-814-2045
Practice Address - Fax:425-814-2783
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60592253175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2048750Medicaid