Healthcare Provider Details

I. General information

NPI: 1427694736
Provider Name (Legal Business Name): BREANNE PINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3607
  • Fax: 319-235-3958
Mailing address:
  • Phone: 319-235-3607
  • Fax: 319-235-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA157447
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG180392
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: