Healthcare Provider Details

I. General information

NPI: 1639975386
Provider Name (Legal Business Name): REBECCA RENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 MAIN ST
VANCOUVER WA
98660-2607
US

IV. Provider business mailing address

1711 MAIN ST
VANCOUVER WA
98660-2607
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-4481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61637172
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: