Provider Demographics
NPI:1700180056
Name:RAVENEL, BROOKE ROXANNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:ROXANNE
Last Name:RAVENEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 LACONIA AVE
Mailing Address - Street 2:APT. #1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4921
Mailing Address - Country:US
Mailing Address - Phone:347-697-7419
Mailing Address - Fax:
Practice Address - Street 1:500 8TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6504
Practice Address - Country:US
Practice Address - Phone:212-904-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225751-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse