Healthcare Provider Details

I. General information

NPI: 1962955807
Provider Name (Legal Business Name): BROOKE GELECKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROADRUNNER PKWY
LAS CRUCES NM
88011-7044
US

IV. Provider business mailing address

150 N ROADRUNNER PKWY
LAS CRUCES NM
88011-7044
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-6440
  • Fax: 575-556-6445
Mailing address:
  • Phone: 575-556-6440
  • Fax: 755-566-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-03466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: