Healthcare Provider Details

I. General information

NPI: 1477382851
Provider Name (Legal Business Name): BROOKE JEANMARIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LOYOLA AVE STE 106
NEW ORLEANS LA
70113-1912
US

IV. Provider business mailing address

12501 N LAKE CARMEL DR
NEW ORLEANS LA
70128-4580
US

V. Phone/Fax

Practice location:
  • Phone: 504-558-9595
  • Fax:
Mailing address:
  • Phone: 504-292-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: