Healthcare Provider Details

I. General information

NPI: 1518583657
Provider Name (Legal Business Name): MS. REBECCA ANN BRUBAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4402
US

IV. Provider business mailing address

7555 CORMAC ST
MCKINNEY TX
75071-1557
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-8480
  • Fax:
Mailing address:
  • Phone: 214-455-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1000544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: