Provider Demographics
NPI:1124552021
Name:LINCOLN, BRENTINA
Entity Type:Individual
Prefix:
First Name:BRENTINA
Middle Name:
Last Name:LINCOLN
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 1:101 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:TOKSOOK BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99637
Mailing Address - Country:US
Mailing Address - Phone:907-427-3500
Mailing Address - Fax:907-427-3526
Practice Address - Street 1:101 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:TOKSOOK BAY
Practice Address - State:AK
Practice Address - Zip Code:99637
Practice Address - Country:US
Practice Address - Phone:907-427-3500
Practice Address - Fax:907-427-3526
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker