Provider Demographics
NPI:1669976742
Name:LONG, BROOKE RENEE (CNP, RN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:RENEE
Last Name:LONG
Suffix:
Gender:F
Credentials:CNP, RN
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:RENEE
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP, RN
Mailing Address - Street 1:2820 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5474
Mailing Address - Country:US
Mailing Address - Phone:605-342-3280
Mailing Address - Fax:
Practice Address - Street 1:2820 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5474
Practice Address - Country:US
Practice Address - Phone:605-342-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR042964163W00000X
MN5930363LF0000X
SDCP001924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse