Healthcare Provider Details

I. General information

NPI: 1891288668
Provider Name (Legal Business Name): REBECCA BRINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MAIN STREET
OGEMA MN
56569-0022
US

IV. Provider business mailing address

PO BOX 22
OGEMA MN
56569-0022
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-3900
  • Fax: 218-983-3902
Mailing address:
  • Phone: 218-983-3900
  • Fax: 218-983-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE935008832617
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: