Provider Demographics
NPI:1639918311
Name:HARRIS, BROOKE ALISON (LPN)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ALISON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:ALISON
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:14142 SERFASS RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-9746
Mailing Address - Country:US
Mailing Address - Phone:330-573-6864
Mailing Address - Fax:
Practice Address - Street 1:14142 SERFASS RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-9746
Practice Address - Country:US
Practice Address - Phone:330-573-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.103221.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse