Healthcare Provider Details

I. General information

NPI: 1962279596
Provider Name (Legal Business Name): REBECCA BRUNK MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

IV. Provider business mailing address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

V. Phone/Fax

Practice location:
  • Phone: 360-644-1631
  • Fax: 360-644-1655
Mailing address:
  • Phone: 360-644-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10038388
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61648446
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61318937
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: