Provider Demographics
NPI:1053501387
Name:SCHWENK, BROOKE ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANN
Last Name:SCHWENK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 ARCOLA RD
Mailing Address - Street 2:MAIN LINE HEALTH CENTER
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3954
Mailing Address - Country:US
Mailing Address - Phone:484-565-8440
Mailing Address - Fax:610-409-6160
Practice Address - Street 1:599 ARCOLA RD
Practice Address - Street 2:MAIN LINE HEALTH CENTER
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3954
Practice Address - Country:US
Practice Address - Phone:484-565-8440
Practice Address - Fax:610-409-6160
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA188664HK1Medicare PIN