Healthcare Provider Details

I. General information

NPI: 1194354662
Provider Name (Legal Business Name): MELISSA KRISTIN BRUEBAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA ST
OAK HARBOR WA
98278-4927
US

IV. Provider business mailing address

3475 N SARATOGA ST
OAK HARBOR WA
98278-4927
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9500
  • Fax:
Mailing address:
  • Phone: 360-257-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101273201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: