Healthcare Provider Details

I. General information

NPI: 1700796174
Provider Name (Legal Business Name): BROOKE NICOLE STEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 PARK ROWE AVE
BATON ROUGE LA
70810-1686
US

IV. Provider business mailing address

3219 EMILY DR
PORT ALLEN LA
70767-5947
US

V. Phone/Fax

Practice location:
  • Phone: 225-287-5206
  • Fax:
Mailing address:
  • Phone: 225-287-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: