Provider Demographics
NPI:1083238331
Name:HUFFMAN, BROOKE ANN (RN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 W 1300 S
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46982-8528
Mailing Address - Country:US
Mailing Address - Phone:574-551-7690
Mailing Address - Fax:
Practice Address - Street 1:5332 W 1300 S
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:IN
Practice Address - Zip Code:46982-8528
Practice Address - Country:US
Practice Address - Phone:574-551-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0020151367500000X
IN28206834A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse