Provider Demographics
NPI:1669672382
Name:LE BRUN, BETTY LYNN (RN, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:LYNN
Last Name:LE BRUN
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2216
Mailing Address - Country:US
Mailing Address - Phone:530-846-9080
Mailing Address - Fax:530-846-4015
Practice Address - Street 1:3810 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2722
Practice Address - Country:US
Practice Address - Phone:509-221-7000
Practice Address - Fax:509-221-5897
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0807308OtherNATIONAL ID NUMBER
WA30007800OtherWA AP #
CA17448OtherFNP CA
WA30007800OtherWA AP #