Healthcare Provider Details

I. General information

NPI: 1518279959
Provider Name (Legal Business Name): KRISTINE ELLEN BRENC NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 NE VALLEY RD
PULLMAN WA
99163-3845
US

IV. Provider business mailing address

915 NE VALLEY RD
PULLMAN WA
99163-3845
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-3548
  • Fax: 509-332-5253
Mailing address:
  • Phone: 509-332-3548
  • Fax: 509-332-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 60172244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: