Provider Demographics
NPI:1831367176
Name:BRINK, AURA LEE (RD)
Entity type:Individual
Prefix:
First Name:AURA
Middle Name:LEE
Last Name:BRINK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 SYLVAN LAKE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-0129
Mailing Address - Country:US
Mailing Address - Phone:970-328-6357
Mailing Address - Fax:970-328-5633
Practice Address - Street 1:377 SYLVAN LAKE ROAD SUITE 220
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-328-6357
Practice Address - Fax:970-328-5633
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO956012133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300645OtherINDIVIDUAL PTAN
CU5608OtherGROUP PTAN
1831367176OtherNPI NUMBER