Healthcare Provider Details

I. General information

NPI: 1114399268
Provider Name (Legal Business Name): GINA BRINATTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HOOVER DR STE A
NORTH MANKATO MN
56003-2669
US

IV. Provider business mailing address

823 5TH ST
NICOLLET MN
56074-2024
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-2037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number202004
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: