Provider Demographics
NPI:1912683541
Name:BRINK, MADISON RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RAE
Last Name:BRINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:715 BEECH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9131
Mailing Address - Country:US
Mailing Address - Phone:616-566-9002
Mailing Address - Fax:
Practice Address - Street 1:201 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1825
Practice Address - Country:US
Practice Address - Phone:231-629-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant