Provider Demographics
NPI:1477267805
Name:BRICKNER, AUSTIN DALE
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DALE
Last Name:BRICKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5874
Mailing Address - Country:US
Mailing Address - Phone:916-730-6383
Mailing Address - Fax:
Practice Address - Street 1:347 QUAIL DR
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5874
Practice Address - Country:US
Practice Address - Phone:916-730-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266019164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse