Provider Demographics
NPI:1659150654
Name:MERLE, BROOKE ELISE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELISE
Last Name:MERLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21900 E COUNTRY VISTA DR UNIT O101
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5172
Mailing Address - Country:US
Mailing Address - Phone:804-461-1413
Mailing Address - Fax:
Practice Address - Street 1:21900 E COUNTRY VISTA DR UNIT O101
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5172
Practice Address - Country:US
Practice Address - Phone:804-461-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61422084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily