Provider Demographics
NPI:1841591864
Name:PHENICIE, BROOKE BASSETT (NP-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:BASSETT
Last Name:PHENICIE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3147 VALCOUR DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-6902
Mailing Address - Country:US
Mailing Address - Phone:260-243-1440
Mailing Address - Fax:
Practice Address - Street 1:1460 N HALSTED ST STE 501
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2615
Practice Address - Country:US
Practice Address - Phone:773-388-6390
Practice Address - Fax:312-867-7101
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041390638163W00000X
IN71003442A363LF0000X
IL209008732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse