Healthcare Provider Details

I. General information

NPI: 1427971233
Provider Name (Legal Business Name): JORDAN BRINK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 11TH ST NW
WADENA MN
56482-1044
US

IV. Provider business mailing address

48033 380TH ST
NEW YORK MILLS MN
56567-9138
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-3510
  • Fax:
Mailing address:
  • Phone: 218-639-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14548
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: