Healthcare Provider Details

I. General information

NPI: 1699230896
Provider Name (Legal Business Name): BROOKE E MACLENNAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SIERRA ROSE DR STE 204
RENO NV
89511-4026
US

IV. Provider business mailing address

645 SIERRA ROSE DR STE 204
RENO NV
89511-4026
US

V. Phone/Fax

Practice location:
  • Phone: 775-432-7339
  • Fax: 775-683-9820
Mailing address:
  • Phone: 775-432-7339
  • Fax: 775-683-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number816896
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: