Healthcare Provider Details

I. General information

NPI: 1962082602
Provider Name (Legal Business Name): DANYELLE BROOKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WARRIOR DR.
VINCENT OH
45784
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-541-8922
  • Fax:
Mailing address:
  • Phone: 740-773-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: