Provider Demographics
NPI:1114473139
Name:MALICOTE, BROOKE N (LPN-MEDS-IV)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:N
Last Name:MALICOTE
Suffix:
Gender:F
Credentials:LPN-MEDS-IV
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:N
Other - Last Name:KREIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN-MEDS
Mailing Address - Street 1:204 COOK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9600
Mailing Address - Country:US
Mailing Address - Phone:513-228-7800
Mailing Address - Fax:513-695-2952
Practice Address - Street 1:953 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2921
Practice Address - Country:US
Practice Address - Phone:937-383-4441
Practice Address - Fax:937-383-2916
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN-153388-MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse