Provider Demographics
NPI:1952729238
Name:MOTTER, BROOKE ANN
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:MOTTER
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 1:907 WOODHILL CT
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8922
Mailing Address - Country:US
Mailing Address - Phone:612-655-8479
Mailing Address - Fax:
Practice Address - Street 1:907 WOODHILL CT
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8922
Practice Address - Country:US
Practice Address - Phone:612-655-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0712547164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse