Healthcare Provider Details

I. General information

NPI: 1235638529
Provider Name (Legal Business Name): BROOKE DORWART PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 LAKESIDE HILLS PLZ STE 102
OMAHA NE
68130-4656
US

IV. Provider business mailing address

17030 LAKESIDE HILLS PLZ STE 102
OMAHA NE
68130-4656
US

V. Phone/Fax

Practice location:
  • Phone: 402-758-5800
  • Fax: 402-758-5809
Mailing address:
  • Phone: 402-758-5800
  • Fax: 402-758-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2201
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: