=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902602949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATE J DEBRUIN RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2025
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5197 NE LOWER RIVER ROAD
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-205-1222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 632 BAKER ST SE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97321-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-985-0717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN60937973
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------