Provider Demographics
NPI:1922399161
Name:MAYLIE, BROOKE NICOLE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:NICOLE
Last Name:MAYLIE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1500 NW BETHANY BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5208
Mailing Address - Country:US
Mailing Address - Phone:503-644-7300
Mailing Address - Fax:503-641-5179
Practice Address - Street 1:1500 NW BETHANY BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5208
Practice Address - Country:US
Practice Address - Phone:503-644-7300
Practice Address - Fax:503-641-5179
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD278862083P0500X
CAA979272083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine