Healthcare Provider Details

I. General information

NPI: 1174012769
Provider Name (Legal Business Name): BROOKE RENAE ARTHUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 16TH ST
NEW CASTLE IN
47362-4319
US

IV. Provider business mailing address

173 NIXON DR
NEW CASTLE IN
47362-1233
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-0890
  • Fax:
Mailing address:
  • Phone: 765-520-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28163759A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008211A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: