Provider Demographics
NPI:1831443555
Name:DABBERT, BROOKE ELAINE (FNP-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELAINE
Last Name:DABBERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELAINE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:200 HIGH PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4810
Mailing Address - Country:US
Mailing Address - Phone:574-364-2888
Mailing Address - Fax:574-364-2890
Practice Address - Street 1:200 HIGH PARK AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4810
Practice Address - Country:US
Practice Address - Phone:574-364-2888
Practice Address - Fax:574-364-2890
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004324A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201134390Medicaid