Provider Demographics
NPI:1710396601
Name:SKURUPEY, BROOKE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:MARIE
Last Name:SKURUPEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:MARIE
Other - Last Name:CHARITON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 N SCHREIBER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8362
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:3815 N SCHREIBER WAY STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8362
Practice Address - Country:US
Practice Address - Phone:208-755-2804
Practice Address - Fax:208-765-0277
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1457A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner