Healthcare Provider Details

I. General information

NPI: 1396112017
Provider Name (Legal Business Name): BRENDA RANTALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 NE DOCTORS DR STE 7
BEND OR
97701-6324
US

IV. Provider business mailing address

1245 NW 4TH ST STE 201
REDMOND OR
97756-1680
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-3780
  • Fax: 541-598-3492
Mailing address:
  • Phone: 541-323-4545
  • Fax: 541-323-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201506343NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: