NPIMap

Organization Active NPI

Forever Young Two Medical and Skincare

  • Nurse Practitioner
  • Waite Park, MN
National Provider Identifier
1023979598
Registry record updated Nov 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
FOREVER YOUNG TWO MEDICAL AND SKINCARE
Practice address
223 3Rd St NE
Waite Park, MN 56387-1271
Phone
(763) 272-1500
NPI assigned
Nov 22, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carol Marguerite BrinkmanNPI 1578560405
Title
Owner
Phone
(763) 272-1500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

223 3Rd St NE
Waite Park, MN 56387-1271

Mailing address

223 3Rd St NE
Waite Park, MN 56387-1271
Phone (763) 272-1500

National Provider Directory

National Provider Directory

Locations

223 3rd St NE
Waite Park, MN 56387
Phone (763) 272-1500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763769600000",
    "number": "1023979598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 3RD ST NE",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871271",
            "telephone_number": "763-272-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 3RD ST NE",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871271",
            "telephone_number": "763-272-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER YOUNG TWO MEDICAL AND SKINCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-22",
        "last_updated": "2025-11-22",
        "certification_date": "2025-11-22",
        "status": "A",
        "authorized_official_last_name": "BRINKMAN",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "MARGUERITE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-272-1500"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waite Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.