Healthcare Provider Details

I. General information

NPI: 1487081618
Provider Name (Legal Business Name): BETH A BRINKMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

PO BOX 5157
VANCOUVER WA
98668-5157
US

V. Phone/Fax

Practice location:
  • Phone: 360-828-5396
  • Fax: 360-828-5455
Mailing address:
  • Phone: 360-828-5396
  • Fax: 360-828-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN123263
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number01277
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60567277
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: