Provider Demographics
NPI:1649090333
Name:YUNKER, BRANDON TY
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:TY
Last Name:YUNKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14666 LIBBY LN SE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-9202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14666 LIBBY LN SE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OR
Practice Address - Zip Code:97352-9202
Practice Address - Country:US
Practice Address - Phone:503-983-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10034143163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse