Provider Demographics
NPI:1891037842
Name:JARDINE, BROOKE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ALLEN
Last Name:JARDINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ORONDO AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:4545 CORDATA PKWY STE 1E
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7264
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5679
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60644639208000000X
WAML 60368469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028850Medicaid