Healthcare Provider Details

I. General information

NPI: 1629835459
Provider Name (Legal Business Name): BROOKE MADERE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 LIBERTY RD
FLOWOOD MS
39232-9300
US

IV. Provider business mailing address

778 LIBERTY RD
FLOWOOD MS
39232-9300
US

V. Phone/Fax

Practice location:
  • Phone: 769-243-6141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number234616
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: