Healthcare Provider Details

I. General information

NPI: 1750326906
Provider Name (Legal Business Name): KATHY SUE BRINKMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAIN STREET
MONROE CITY IN
47557
US

IV. Provider business mailing address

RR 3 BOX 206
LAWRENCEVILLE IL
62439-9465
US

V. Phone/Fax

Practice location:
  • Phone: 812-743-5113
  • Fax:
Mailing address:
  • Phone: 618-928-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002045A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: