1578560405 NPI number — MRS. CAROL MARGUERITE BRINKMAN RN CNP

Table of content: MRS. CAROL MARGUERITE BRINKMAN RN CNP (NPI 1578560405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578560405 NPI number — MRS. CAROL MARGUERITE BRINKMAN RN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINKMAN
Provider First Name:
CAROL
Provider Middle Name:
MARGUERITE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TROJE
Provider Other First Name:
CAROL
Provider Other Middle Name:
MARGUERITE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN CNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578560405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1511 NORTHWAY DR
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-1262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-267-1341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9766 FALLON AVE NE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55362-4589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-272-1500
Provider Business Practice Location Address Fax Number:
763-272-1503
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  0382194 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64350BR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 786175300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 131006D034 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MR143-1043267 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP50654 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 031216004 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-14662 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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