Provider Demographics
NPI:1245749316
Name:SLATER, BROOKE KATHRYN (MSN, RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:KATHRYN
Last Name:SLATER
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 W 3RD ST STE 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5949
Mailing Address - Country:US
Mailing Address - Phone:310-423-4700
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5949
Practice Address - Country:US
Practice Address - Phone:310-423-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1050848363LP0200X
CA95023162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics