Provider Demographics
NPI:1093479396
Name:DONAHUE, BROOKE (MSN, AG-ACNP-BC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:MSN, AG-ACNP-BC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:HOCHSTETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7500 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2319
Mailing Address - Country:US
Mailing Address - Phone:402-398-5880
Mailing Address - Fax:402-398-6716
Practice Address - Street 1:4140 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5537
Practice Address - Country:US
Practice Address - Phone:515-491-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH166526363LA2100X
NE113842363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH14050347OtherDRIVER'S LICENSE NUMBER