Provider Demographics
NPI:1700158326
Name:BIANCHINI, BRANDON KEITH (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:KEITH
Last Name:BIANCHINI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 N LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3330
Mailing Address - Country:US
Mailing Address - Phone:586-322-5467
Mailing Address - Fax:
Practice Address - Street 1:100 E 33RD ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-514-7550
Practice Address - Fax:360-514-7553
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 363AM0700X
WAPA61031683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical