Provider Demographics
NPI:1396376216
Name:IBELING, BROOKE ASHTON
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHTON
Last Name:IBELING
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 1:112 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZEARING
Mailing Address - State:IA
Mailing Address - Zip Code:50278-7728
Mailing Address - Country:US
Mailing Address - Phone:641-487-7800
Mailing Address - Fax:
Practice Address - Street 1:29182 COUNTY HIGHWAY D15
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-7722
Practice Address - Country:US
Practice Address - Phone:641-373-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily