Provider Demographics
NPI:1700636990
Name:VONDERHUEVEL, BROOKE ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXANDRIA
Last Name:VONDERHUEVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 DAKOTA RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2903
Mailing Address - Country:US
Mailing Address - Phone:937-441-4034
Mailing Address - Fax:
Practice Address - Street 1:1305 DAKOTA RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2903
Practice Address - Country:US
Practice Address - Phone:937-441-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.430966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse