Healthcare Provider Details

I. General information

NPI: 1881110690
Provider Name (Legal Business Name): HANNA-MARIE BROCKWAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/13/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
LAKEWOOD WA
98499
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
LAKEWOOD WA
98499
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1484
  • Fax:
Mailing address:
  • Phone: 253-968-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number021513
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.11002015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: