Provider Demographics
NPI:1326717448
Name:STEVENS, BROOK (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BROOK
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12491 E 106TH PL
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-7031
Mailing Address - Country:US
Mailing Address - Phone:316-204-3685
Mailing Address - Fax:
Practice Address - Street 1:12491 E 106TH PL
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-7031
Practice Address - Country:US
Practice Address - Phone:316-204-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996921-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care