Provider Demographics
NPI:1609113059
Name:BREN, LYNDA JAYE (BS RN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:JAYE
Last Name:BREN
Suffix:
Gender:F
Credentials:BS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 YELLOWHAWK ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-7727
Mailing Address - Country:US
Mailing Address - Phone:509-522-0717
Mailing Address - Fax:
Practice Address - Street 1:471 YELLOWHAWK ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-7727
Practice Address - Country:US
Practice Address - Phone:509-522-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00155715163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse