Provider Demographics
NPI:1679462709
Name:BRUN, LAILA TANALA (RN, CDN)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:TANALA
Last Name:BRUN
Suffix:
Gender:F
Credentials:RN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 S 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1909
Mailing Address - Country:US
Mailing Address - Phone:253-573-1600
Mailing Address - Fax:253-573-1601
Practice Address - Street 1:3401 S 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1909
Practice Address - Country:US
Practice Address - Phone:253-573-1600
Practice Address - Fax:253-573-1601
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61509419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse