Healthcare Provider Details

I. General information

NPI: 1609015981
Provider Name (Legal Business Name): BROOKE VANDER POL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE SUITE 203
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE SUITE 203
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8150
  • Fax:
Mailing address:
  • Phone: 253-382-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP60074105
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: