Provider Demographics
NPI:1275056608
Name:FIDDELKE, BROOKE (ARNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FIDDELKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E GROESBECK ST
Mailing Address - Street 2:
Mailing Address - City:PAULLINA
Mailing Address - State:IA
Mailing Address - Zip Code:51046-7748
Mailing Address - Country:US
Mailing Address - Phone:712-949-2126
Mailing Address - Fax:712-949-2123
Practice Address - Street 1:131 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:IA
Practice Address - Zip Code:51058-7615
Practice Address - Country:US
Practice Address - Phone:712-446-2567
Practice Address - Fax:712-446-2631
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner