Healthcare Provider Details

I. General information

NPI: 1861150807
Provider Name (Legal Business Name): BROOKE BERGER LIPOW MSN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N BRAND BLVD STE 100
GLENDALE CA
91203-3240
US

IV. Provider business mailing address

2314 S VAL VISTA DR STE 201
GILBERT AZ
85295-5594
US

V. Phone/Fax

Practice location:
  • Phone: 747-286-2600
  • Fax:
Mailing address:
  • Phone: 208-651-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95019341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: