Healthcare Provider Details

I. General information

NPI: 1326020884
Provider Name (Legal Business Name): MICHELLE BRINKOP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6884 HANNEGAN RD
EVERSON WA
98247-9637
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-0766
  • Fax: 360-354-7667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61486672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: