Provider Demographics
NPI:1295422319
Name:BRINSON, MICHAEL (RN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BRINSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3068
Mailing Address - Country:US
Mailing Address - Phone:618-202-8611
Mailing Address - Fax:
Practice Address - Street 1:4830 RED OAK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3068
Practice Address - Country:US
Practice Address - Phone:618-202-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle