Healthcare Provider Details

I. General information

NPI: 1205474921
Provider Name (Legal Business Name): BROOKE WOLFE GREGORY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ANNETTE WOLFE

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13886 MOUNT CALVARY RD
LOOGOOTEE IN
47553-4788
US

IV. Provider business mailing address

13886 MOUNT CALVARY RD
LOOGOOTEE IN
47553-4788
US

V. Phone/Fax

Practice location:
  • Phone: 812-486-8697
  • Fax:
Mailing address:
  • Phone: 812-486-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71009664A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009664A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: