Provider Demographics
NPI:1629058748
Name:IRWIN, BRANDI LEA (DO)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEA
Last Name:IRWIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 164TH STREET SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 164TH STREET SE
Practice Address - Street 2:SUITE 100
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-354-4296
Practice Address - Fax:425-332-3495
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7558208000000X
WAOP00002348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics