Provider Demographics
NPI:1073911947
Name:BROOKLYN, REBECCA (APRN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:BROOKLYN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 ST GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7695
Mailing Address - Country:US
Mailing Address - Phone:802-922-2520
Mailing Address - Fax:802-879-5335
Practice Address - Street 1:4185 ST GEORGE RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7695
Practice Address - Country:US
Practice Address - Phone:802-922-2520
Practice Address - Fax:802-879-5335
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0108513363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health