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General NPI Number Information
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NPI Number | 1457500332
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Entity Type | Individual
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Provider Name | BROOKE PEARSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 5610 W GAGE ST
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City | BOISE
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State | ID
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Zip | 83706-1349
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Country | US
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Telephone | 208-501-8955
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Fax | 208-370-3382
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Provider Business Mailing Address
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Address Line | 45640 SCHOENHERR RD STE B
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-6033
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Country | US
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Telephone | 586-247-4300
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP1507A
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License Number State | ID
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