Healthcare Provider Details

I. General information

NPI: 1164962379
Provider Name (Legal Business Name): BROOKE DAGER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE HALEY

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 HORIZON CT STE 220
GRAND JUNCTION CO
81506-8716
US

IV. Provider business mailing address

670 PARK AVE PO BOX 990
SHELBY MT
59474-1663
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 406-434-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number119094
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0100899-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: