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General NPI Number Information
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NPI Number | 1760367098
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Entity Type | Individual
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Provider Name | REBECKA MULLENBACH
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 9900 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-9777
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Country | US
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Telephone | 503-571-3653
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Fax |
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Provider Business Mailing Address
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Address Line | 7808 SE ASPEN SUMMIT DR APT 16
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City | PORTLAND
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State | OR
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Zip | 97266-6165
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Country | US
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Telephone | 612-998-1763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0800X
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Taxonomy Name | Orthopedic Registered Nurse
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License Number | RN61684446
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 202005596RN
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License Number State | OR
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