Provider Demographics
NPI:1730665597
Name:HALL, BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-232-0564
Mailing Address - Fax:812-242-4590
Practice Address - Street 1:315 LANKFORD ST
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IN
Practice Address - Zip Code:47841-1008
Practice Address - Country:US
Practice Address - Phone:812-939-2126
Practice Address - Fax:812-939-3414
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008106A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner