1891337747 NPI number — SHEILA R BRINKMAN APRN, FNP-C

Table of content: SHEILA R BRINKMAN APRN, FNP-C (NPI 1891337747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891337747 NPI number — SHEILA R BRINKMAN APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINKMAN
Provider First Name:
SHEILA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891337747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6059
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75608-6059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-918-8520
Provider Business Mailing Address Fax Number:
186-684-2164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 ITHACA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75604-0610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-918-8520
Provider Business Practice Location Address Fax Number:
866-842-1649
Provider Enumeration Date:
10/11/2019

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: 207Q00000X , with the licence number:  AP140963 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP140693 . This is a "LICENSE TO PRACTICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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