Healthcare Provider Details

I. General information

NPI: 1164336376
Provider Name (Legal Business Name): BROOKE ELYSE NEWMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 23RD AVE
SAN FRANCISCO CA
94116-1213
US

IV. Provider business mailing address

1777 CLEMENT AVE APT 520
ALAMEDA CA
94501-8088
US

V. Phone/Fax

Practice location:
  • Phone: 510-406-1049
  • Fax:
Mailing address:
  • Phone: 714-287-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95162402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: