Provider Demographics
NPI:1356781934
Name:BRINK, ELIZABETH LEE (CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:BRINK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 GALLOPING GOOSE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2915
Mailing Address - Country:US
Mailing Address - Phone:719-367-9405
Mailing Address - Fax:719-434-9777
Practice Address - Street 1:5028 GALLOPING GOOSE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-367-9405
Practice Address - Fax:719-434-9777
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60502401163WX0003X
COAPN.0993812-CNM176B00000X, 367A00000X
WAAP60696895367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No176B00000XOther Service ProvidersMidwife