Provider Demographics
NPI:1003055492
Name:GUM, BROOKE (MN, ARNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GUM
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:SLATER, MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3321 W KENNEWICK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2968
Mailing Address - Country:US
Mailing Address - Phone:509-735-6446
Mailing Address - Fax:509-492-3040
Practice Address - Street 1:3321 W KENNEWICK AVE STE 150
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2968
Practice Address - Country:US
Practice Address - Phone:509-735-6446
Practice Address - Fax:509-492-3040
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN128078163W00000X
WARN00157565163W00000X
WAAP60074110363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse