Provider Demographics
NPI:1144877242
Name:BRINKMEYER, SUSAN ALICE
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALICE
Last Name:BRINKMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ASH ST.
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:IA
Mailing Address - Zip Code:50122
Mailing Address - Country:US
Mailing Address - Phone:515-360-8153
Mailing Address - Fax:
Practice Address - Street 1:202 ASH ST.
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:IA
Practice Address - Zip Code:50122
Practice Address - Country:US
Practice Address - Phone:515-360-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider