Provider Demographics
NPI:1124313259
Name:BRINKS, LACHELLE RENEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LACHELLE
Middle Name:RENEE
Last Name:BRINKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25757 183RD ST
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-1247
Mailing Address - Country:US
Mailing Address - Phone:320-630-3623
Mailing Address - Fax:
Practice Address - Street 1:5 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1421
Practice Address - Country:US
Practice Address - Phone:218-546-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 169549-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily