Provider Demographics
NPI:1639363823
Name:DUGAN, BROOKE RENEE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:RENEE
Last Name:DUGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130
Mailing Address - Country:US
Mailing Address - Phone:740-687-0100
Mailing Address - Fax:740-687-0145
Practice Address - Street 1:784 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3983
Practice Address - Country:US
Practice Address - Phone:740-687-0100
Practice Address - Fax:740-687-0145
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15214174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist