Basic Information
| Provider Information | |||||||||
| NPI: | 1588641765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRINK | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 PLEASANT ST | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152438842 | ||||||||
| FaxNumber: | 5152829806 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 PLEASANT ST | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152438842 | ||||||||
| FaxNumber: | 5152829806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34043 | IA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1241323 | 05 | IA | MEDICAID | 0241323 | 05 | IA | MEDICAID | 160053213 | 01 | IA | RR MEDICARE | OTHER | 1588641765 | 05 | IA | MEDICAID |