Provider Demographics
NPI:1215763628
Name:BRUNKHORST, EMILY STEVENSON (AGACNP)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:STEVENSON
Last Name:BRUNKHORST
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 S. BOND AVE
Mailing Address - Street 2:APT #607
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:253-797-5059
Mailing Address - Fax:
Practice Address - Street 1:3939 S. BOND AVE
Practice Address - Street 2:APT #607
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:253-797-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10031087363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care