Provider Demographics
NPI:1689223356
Name:EISCHENS, BROOKE INEZ ELLINGSON (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:INEZ ELLINGSON
Last Name:EISCHENS
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:INEZ
Other - Last Name:ELLINGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:333 SIBLEY ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2689
Mailing Address - Country:US
Mailing Address - Phone:612-716-2751
Mailing Address - Fax:
Practice Address - Street 1:968 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3014
Practice Address - Country:US
Practice Address - Phone:651-895-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9511-33367A00000X
MN408367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife