Provider Demographics
NPI:1720749864
Name:DEVORE, BROOKE ALLISON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ALLISON
Last Name:DEVORE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:640 S STATE ST # MC3055
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:1012 MATTLIND WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5300
Practice Address - Country:US
Practice Address - Phone:024-240-6003
Practice Address - Fax:302-422-6214
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2024-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0011876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty