Healthcare Provider Details

I. General information

NPI: 1538070313
Provider Name (Legal Business Name): BROOKE PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
YOUNGSTOWN OH
44512-6725
US

IV. Provider business mailing address

1579 THALIA AVE
YOUNGSTOWN OH
44514-1138
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-2929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0043312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: