Provider Demographics
NPI:1285816264
Name:ELLIOTT, BROOKE MAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MAE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:STE 450
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2325
Mailing Address - Country:US
Mailing Address - Phone:360-904-6694
Mailing Address - Fax:
Practice Address - Street 1:14201 NE 20TH AVE STE 3103
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6414
Practice Address - Country:US
Practice Address - Phone:360-571-9799
Practice Address - Fax:360-576-6320
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA10332363AM0700X
WAPA10005303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical