Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F-074743 | IA |
NPI | 1083693733 |
---|---|
Provider Name | Terri L Brinck |
First Address | Davenport, IA 52807-3928 |
Second Address | Burlington, IA 52601-4608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 11/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
220438 | IOWA HEALTH SOLUTIONS (01) | IA |
41396 | WELLMARK (01) | IA |
P-26533 | (02) | IA |