Healthcare Provider Details

I. General information

NPI: 1114668373
Provider Name (Legal Business Name): BROOKE BIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 04/04/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 TRAILS END RD
LAS CRUCES NM
88007-6059
US

IV. Provider business mailing address

1985 TRAILS END RD
LAS CRUCES NM
88007-6059
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-0542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: