Healthcare Provider Details

I. General information

NPI: 1780534495
Provider Name (Legal Business Name): AMBER DEBRUIN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21155 N 56TH ST APT 1104
PHOENIX AZ
85054-5541
US

IV. Provider business mailing address

21155 N 56TH ST APT 1104
PHOENIX AZ
85054-5541
US

V. Phone/Fax

Practice location:
  • Phone: 609-678-6977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234643
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: