Healthcare Provider Details

I. General information

NPI: 1730969205
Provider Name (Legal Business Name): BROOKE HEPPLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 WHITNEY AVE
HAMDEN CT
06518-2561
US

IV. Provider business mailing address

51 WELLES DR
NEWINGTON CT
06111-2626
US

V. Phone/Fax

Practice location:
  • Phone: 860-808-4734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12472
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: