Provider Demographics
NPI:1255847059
Name:MALESZEWSKI, BROOKE
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:MALESZEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:DARGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:586-713-8587
Mailing Address - Fax:
Practice Address - Street 1:821 3RD AVE SE STE 15
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904
Practice Address - Country:US
Practice Address - Phone:507-292-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5996OtherMN BOARD OF NURSING