Healthcare Provider Details

I. General information

NPI: 1548759855
Provider Name (Legal Business Name): SUMMER BRYAN CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YELLOWHAWK TRIBAL HEALTH CENTER 46314 TIMINE WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

YELLOWHAWK TRIBAL HEALTH CENTER PO BOX 160
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-962-0119
Mailing address:
  • Phone: 541-966-9830
  • Fax: 541-962-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202100591RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: