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General NPI Number Information
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NPI Number | 1649851734
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Entity Type | Individual
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Provider Name | NICHOLE BROEKHUIS RN, BSN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 721 MIAMI CHAPEL RD
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City | DAYTON
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State | OH
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Zip | 45417-4650
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Country | US
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Telephone | 937-281-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 721 MIAMI CHAPEL RD
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City | DAYTON
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State | OH
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Zip | 45417-4650
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Country | US
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Telephone | 937-901-2777
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-185641
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN.CNP0036317
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.423570
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-185641
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License Number State | AL
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