Provider Demographics
NPI:1194081307
Name:IMMINK, BRITTANY MANNERS (PA)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:MANNERS
Last Name:IMMINK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SHANGRI LA CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9105
Mailing Address - Country:US
Mailing Address - Phone:517-290-2078
Mailing Address - Fax:
Practice Address - Street 1:358 SHANGRI LA CIR
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-9105
Practice Address - Country:US
Practice Address - Phone:517-290-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant