Provider Demographics
NPI:1639505092
Name:BRINKMAN, PATRICIA LYNN (RDH, MS, COM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:RDH, MS, COM
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:BRINKMAN-FALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8911 WHISPERING WIND RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9278
Mailing Address - Country:US
Mailing Address - Phone:402-759-2561
Mailing Address - Fax:
Practice Address - Street 1:8911 WHISPERING WIND RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9278
Practice Address - Country:US
Practice Address - Phone:402-759-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
613124Q00000X
175-C-12174400000X
NE67125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026255400Medicaid