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General NPI Number Information
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NPI Number | 1588200091
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Entity Type | Organization
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Legal Business Name | BRIGHT MIND LLC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 151 SW SHEVLIN HIXON DR
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City | BEND
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State | OR
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Zip | 97702-3209
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Country | US
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Telephone | 541-717-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 121 NW BOND ST
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City | BEND
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State | OR
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Zip | 97703-3207
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Country | US
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Telephone | 206-225-8780
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER OWNER, PRESIDENT
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Name | AMY KREUTZER ERBER
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Credential | NP
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Telephone | 541-717-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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