Healthcare Provider Details

I. General information

NPI: 1437080058
Provider Name (Legal Business Name): BRIANNA LAYNE BURKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NW KINGS BLVD
CORVALLIS OR
97330-3900
US

IV. Provider business mailing address

PO BOX 1284
CORVALLIS OR
97339-1284
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA229453
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: