Provider Demographics
NPI:1508354820
Name:STREETT, BROOKE DANIELLE (DO)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:DANIELLE
Last Name:STREETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRANCH HEALTH CLINIC CHINA LAKE 1 ADMINISTRATION CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-939-8030
Mailing Address - Fax:
Practice Address - Street 1:BRANCH HEALTH CLINIC CHINA LAKE 1 ADMINISTRATION CIRCLE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-6104
Practice Address - Country:US
Practice Address - Phone:760-939-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
MO2019043340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider