Provider Demographics
NPI:1518678028
Name:DEVITO, BROOKE JACLYN (MSN, RN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:JACLYN
Last Name:DEVITO
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 DUNCAN WAY
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4207
Mailing Address - Country:US
Mailing Address - Phone:937-829-0888
Mailing Address - Fax:
Practice Address - Street 1:VANEO HEALTH CARE SYSTEM
Practice Address - Street 2:10701 EAST BOULEVARD
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-701-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340842163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse