Provider Demographics
NPI:1619579737
Name:HOLMGREN, BROOKE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 BRONCO DR
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9736
Mailing Address - Country:US
Mailing Address - Phone:330-858-8372
Mailing Address - Fax:
Practice Address - Street 1:141 N FORGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1407
Practice Address - Country:US
Practice Address - Phone:330-375-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006650RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical