Provider Demographics
NPI:1619799962
Name:BRUHN, TIMOTHY (EMT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BRUHN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98303-9713
Mailing Address - Country:US
Mailing Address - Phone:360-348-3732
Mailing Address - Fax:
Practice Address - Street 1:12207 LAKE JOSEPHINE BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98303-8709
Practice Address - Country:US
Practice Address - Phone:360-348-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5526-6562-7034146N00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic