Individual provider Active NPI

Roxanne Lane-Brink, RNC, WHCNP

  • Women's Health Nurse Practitioner
  • Gilbert, AZ
National Provider Identifier
1407971153
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
AP0343 Issued in AZ
Practice address
3815 S. Val Vista Drive
Suite 101
Gilbert, AZ 85297-7309
Phone
(480) 782-0993
Fax
(855) 329-8939
NPI assigned
Mar 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X AP0343 AZ Primary

Addresses

Primary practice location

3815 S. Val Vista Drive
Suite 101
Gilbert, AZ 85297-7309

Mailing address

3815 S. Val Vista Drive
Suite 101
Gilbert, AZ 85297-7309
Phone (480) 782-0993

Other identifiers 1

IdentifierTypeStateIssuer
356946MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AP0343AZMDWomen's Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1407971153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 S. VAL VISTA DRIVE",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852977309",
            "telephone_number": "480-782-0993",
            "fax_number": "855-329-8939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 S. VAL VISTA DRIVE",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852977309",
            "telephone_number": "480-782-0993",
            "fax_number": "855-329-8939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE-BRINK",
        "first_name": "ROXANNE",
        "credential": "RNC, WHCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "AZ",
            "license": "AP0343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356946",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.