Provider Demographics
NPI:1699801894
Name:BRYANT, REBECCA LUNDIN (RN BSN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LUNDIN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14038 SE UPPER ALDERCREST DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1809
Mailing Address - Country:US
Mailing Address - Phone:503-786-9422
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD UNIT 9C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-808-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse