1184290652 NPI number — BROOKE R GRASSMYER MSN,APRN,FNP-C

Table of content: BROOKE R GRASSMYER MSN,APRN,FNP-C (NPI 1184290652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184290652 NPI number — BROOKE R GRASSMYER MSN,APRN,FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRASSMYER
Provider First Name:
BROOKE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,APRN,FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184290652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 MOUNTAIN VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYRONE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16686-7210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-207-5319
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 ALLEGHENY ST STE 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLIDAYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16648-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-433-2632
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com