Healthcare Provider Details

I. General information

NPI: 1699801894
Provider Name (Legal Business Name): REBECCA LUNDIN BRYANT RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD UNIT 9C
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

14038 SE UPPER ALDERCREST DR
MILWAUKIE OR
97267-1809
US

V. Phone/Fax

Practice location:
  • Phone: 503-808-1902
  • Fax:
Mailing address:
  • Phone: 503-786-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: