Healthcare Provider Details

I. General information

NPI: 1104127463
Provider Name (Legal Business Name): BROOKE ELLEN ALLEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W NEWTON ST SUITE 10
GREENSBURG PA
15601-2861
US

IV. Provider business mailing address

622 ENGLISHMAN HILL RD
CONNELLSVILLE PA
15425-9346
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-7045
  • Fax: 724-832-9165
Mailing address:
  • Phone: 724-984-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP011033
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: