=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356510655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANINE IRENE BRINK FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601B W WASHINGTON ST
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-781-8448
-----------------------------------------------------
Fax | 315-781-8444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 MAIDEN LANE PO BOX 423
-----------------------------------------------------
City | PENN YAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14527-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-531-9102
-----------------------------------------------------
Fax | 315-531-9103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 631368
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 340861
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------