Healthcare Provider Details

I. General information

NPI: 1275144099
Provider Name (Legal Business Name): BROOKE A ELLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 700
SILVER SPRING MD
20901-4461
US

IV. Provider business mailing address

10552 HUNTERS WAY
LAUREL MD
20723-5724
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-6772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR217302
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: