Provider Demographics
NPI:1629668736
Name:BLUM, BROOKE MACLEAN (NNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MACLEAN
Last Name:BLUM
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:MACLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3442 KENSINGTON PARC CIR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1779
Mailing Address - Country:US
Mailing Address - Phone:678-787-6526
Mailing Address - Fax:
Practice Address - Street 1:3442 KENSINGTON PARC CIR
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1779
Practice Address - Country:US
Practice Address - Phone:678-787-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230977363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty