Healthcare Provider Details

I. General information

NPI: 1629584099
Provider Name (Legal Business Name): BROOKE CARPENTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BUCHANAN ST
SAN FRANCISCO CA
94115-1925
US

IV. Provider business mailing address

2474 WASHINGTON ST APT 104
SAN FRANCISCO CA
94115-1843
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6000
  • Fax:
Mailing address:
  • Phone: 678-438-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95007500
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95007500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: