Provider Demographics
NPI:1730313644
Name:KUZMIC, BROOKE ELLEN (LVN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELLEN
Last Name:KUZMIC
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 6TH ST
Mailing Address - Street 2:#17
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6164
Mailing Address - Country:US
Mailing Address - Phone:714-916-3188
Mailing Address - Fax:562-596-2286
Practice Address - Street 1:234 6TH ST
Practice Address - Street 2:#17
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6164
Practice Address - Country:US
Practice Address - Phone:714-916-3188
Practice Address - Fax:562-596-2286
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN203015164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse