Provider Demographics
NPI:1861027666
Name:BRINKMAN, LINDA W
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:W
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 1:3S854 FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554
Mailing Address - Country:US
Mailing Address - Phone:630-557-2297
Mailing Address - Fax:
Practice Address - Street 1:3S854 FINLEY RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:630-557-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004594133V00000X
IA081212133V00000X
WI2915-29133V00000X
437352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered