Provider Demographics
NPI:1407560154
Name:BUROKER, BROOKE (LPN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BUROKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 STATE ROUTE 235
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-9517
Mailing Address - Country:US
Mailing Address - Phone:567-674-1780
Mailing Address - Fax:
Practice Address - Street 1:4697 STATE ROUTE 235
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-9517
Practice Address - Country:US
Practice Address - Phone:567-674-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse