Provider Demographics
NPI:1609157189
Name:BRUSSEAU, BROOKE (CNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BRUSSEAU
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W 22ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1514
Mailing Address - Country:US
Mailing Address - Phone:605-328-3841
Mailing Address - Fax:
Practice Address - Street 1:1508 W 22ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1514
Practice Address - Country:US
Practice Address - Phone:605-328-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000662164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse