Provider Demographics
NPI:1558047340
Name:BRINKMAN, REVI CHARI MANIPOL
Entity Type:Individual
Prefix:
First Name:REVI CHARI
Middle Name:MANIPOL
Last Name:BRINKMAN
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 1:9437 S 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457
Mailing Address - Country:US
Mailing Address - Phone:714-343-7712
Mailing Address - Fax:
Practice Address - Street 1:9437 S 84TH AVE
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457
Practice Address - Country:US
Practice Address - Phone:714-343-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041472676363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology