Provider Demographics
NPI:1922894625
Name:GEORGIS, BRENNA SUE
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:SUE
Last Name:GEORGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 34TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7525
Mailing Address - Country:US
Mailing Address - Phone:425-249-6607
Mailing Address - Fax:
Practice Address - Street 1:3400 188TH ST SW STE 220
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4785
Practice Address - Country:US
Practice Address - Phone:701-404-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy