Provider Demographics
NPI:1235367152
Name:ROSENBERG, BROOKE WHITLEY (PA)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:WHITLEY
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6512 SIX FORKS RD
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6561
Mailing Address - Country:US
Mailing Address - Phone:919-870-8845
Mailing Address - Fax:919-870-8882
Practice Address - Street 1:6512 SIX FORKS RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6561
Practice Address - Country:US
Practice Address - Phone:919-870-8845
Practice Address - Fax:919-870-8882
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001001849363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant