Provider Demographics
NPI:1184486151
Name:RIVENBURGH, BRANDY LINN (RN)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LINN
Last Name:RIVENBURGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-3201
Mailing Address - Country:US
Mailing Address - Phone:360-921-3635
Mailing Address - Fax:
Practice Address - Street 1:5400 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7049
Practice Address - Country:US
Practice Address - Phone:360-759-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149291163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse