Healthcare Provider Details

I. General information

NPI: 1871164236
Provider Name (Legal Business Name): BROOKE M THOM DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/21/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S 12TH ST STE 101
BISMARCK ND
58504-5941
US

IV. Provider business mailing address

55 1ST AVE E
TURTLE LAKE ND
58575-4205
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-4242
  • Fax:
Mailing address:
  • Phone: 701-448-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR41758
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: