Provider Demographics
NPI:1245361294
Name:BRADEN, AMY MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23807 23RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9207
Mailing Address - Country:US
Mailing Address - Phone:425-290-6024
Mailing Address - Fax:425-290-8016
Practice Address - Street 1:4803 84TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3023
Practice Address - Country:US
Practice Address - Phone:425-290-6024
Practice Address - Fax:425-290-8016
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist