Provider Demographics
NPI:1366038424
Name:WILLIAMS, BROOKE A
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EXCELA HEALTH DR STE 202B
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-532-5360
Mailing Address - Fax:724-879-4033
Practice Address - Street 1:100 EXCELA HEALTH DR STE 202B
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-532-5360
Practice Address - Fax:724-879-4033
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily