Basic Information
Provider Information | |||||||||
NPI: | 1427399906 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TORRES BRINK | ||||||||
FirstName: | MAYRA | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BRINK | ||||||||
OtherFirstName: | MAYRA | ||||||||
OtherMiddleName: | A. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 180 CHURCH HILL RD STE 1 | ||||||||
Address2: |   | ||||||||
City: | LEEDS | ||||||||
State: | ME | ||||||||
PostalCode: | 042633418 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2075243501 | ||||||||
FaxNumber: | 2075242093 | ||||||||
Practice Location | |||||||||
Address1: | 11 ACADEMY RD | ||||||||
Address2: |   | ||||||||
City: | MONMOUTH | ||||||||
State: | ME | ||||||||
PostalCode: | 042597035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2075243501 | ||||||||
FaxNumber: | 2079339645 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/08/2013 | ||||||||
LastUpdateDate: | 10/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/04/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA319 | ME | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
No ID Information.