Provider Demographics
NPI:1518744465
Name:JOHNSON, BROOKE AUSTYN (RN)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:AUSTYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WEWATTA ST STE 350
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5553
Mailing Address - Country:US
Mailing Address - Phone:866-808-6005
Mailing Address - Fax:
Practice Address - Street 1:1 ICE CREAM DR
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-3300
Practice Address - Country:US
Practice Address - Phone:716-317-5428
Practice Address - Fax:716-317-5428
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY823493163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice