Provider Demographics
NPI:1851794390
Name:WALLS, BROOKE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MARIE
Last Name:WALLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:MARIE
Other - Last Name:RUGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-688-7880
Mailing Address - Fax:319-688-7881
Practice Address - Street 1:540 E JEFFERSON ST STE 205
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2479
Practice Address - Country:US
Practice Address - Phone:319-688-7880
Practice Address - Fax:319-688-7881
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant