Provider Demographics
NPI:1235660242
Name:LUPPLACE, BROOK (RN)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:LUPPLACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BROOK
Other - Middle Name:L
Other - Last Name:CRANMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1091 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:LINN CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:65052-1687
Mailing Address - Country:US
Mailing Address - Phone:573-346-6758
Mailing Address - Fax:
Practice Address - Street 1:1091 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:LINN CREEK
Practice Address - State:MO
Practice Address - Zip Code:65052-1687
Practice Address - Country:US
Practice Address - Phone:573-346-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004020214163WA0400X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WG0600XNursing Service ProvidersRegistered NurseGerontology