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General NPI Number Information
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NPI Number | 1346936481
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Entity Type | Individual
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Provider Name | BROOKE RENAE GROOTERS NP
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Gender | Female
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 755 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2506
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Country | US
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Telephone | 480-412-3684
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 E COLONIAL CT
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City | CHANDLER
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State | AZ
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Zip | 85249-5006
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Country | US
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Telephone | 701-412-3193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 284978
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License Number State | AZ
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