Provider Demographics
NPI:1720456346
Name:VICKER, BROOKE ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:VICKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 W BRIGGS AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2649
Mailing Address - Country:US
Mailing Address - Phone:641-209-9944
Mailing Address - Fax:641-209-9946
Practice Address - Street 1:2709 W BRIGGS AVE
Practice Address - Street 2:STE. 1
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2649
Practice Address - Country:US
Practice Address - Phone:641-209-9944
Practice Address - Fax:641-209-9946
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH116282363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology