Healthcare Provider Details

I. General information

NPI: 1194372110
Provider Name (Legal Business Name): ANNE M BROOKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 98TH ST
BLOOMINGTON MN
55420-4773
US

IV. Provider business mailing address

600 W 98TH ST
BLOOMINGTON MN
55420-4773
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15330
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: