Healthcare Provider Details

I. General information

NPI: 1861010597
Provider Name (Legal Business Name): BROOKE BRADY BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WALNUT ST FL 15
PHILADELPHIA PA
19107-5109
US

IV. Provider business mailing address

840 WALNUT ST FL 15
PHILADELPHIA PA
19107-5109
US

V. Phone/Fax

Practice location:
  • Phone: 215-625-6630
  • Fax:
Mailing address:
  • Phone: 215-625-6630
  • Fax: 215-625-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016056
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: