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General NPI Number Information
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NPI Number | 1144047440
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Entity Type | Organization
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Legal Business Name | BROOKVILLE EXPRESS CARE & WELLNESS CENTER
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 430 ARLINGTON RD STE B
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City | BROOKVILLE
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State | OH
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Zip | 45309-1103
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Country | US
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Telephone | 937-641-9389
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Fax |
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Provider Business Mailing Address
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Address Line | 430 ARLINGTON RD STE B
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City | BROOKVILLE
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State | OH
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Zip | 45309-1103
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Country | US
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Telephone | 937-741-4888
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. SHELBY GONSALES
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Credential | APRN-CNP
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Telephone | 937-867-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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