Provider Demographics
NPI:1780960633
Name:MCDOUGALL, BROOK R (ANP)
Entity type:Individual
Prefix:MRS
First Name:BROOK
Middle Name:R
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3578 KAWKAWLIN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-1730
Mailing Address - Country:US
Mailing Address - Phone:989-684-9058
Mailing Address - Fax:
Practice Address - Street 1:4901 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2841
Practice Address - Country:US
Practice Address - Phone:989-498-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245443363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health