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General NPI Number Information
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NPI Number | 1912529462
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Entity Type | Individual
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Provider Name | BROOKE A NOSOVITSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 2730 COMMERCIAL WAY
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City | MONTROSE
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State | CO
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Zip | 81401-5693
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Country | US
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Telephone | 970-964-4036
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 COMMERCIAL WAY
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City | MONTROSE
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State | CO
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Zip | 81401-5693
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Country | US
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Telephone | 970-964-4036
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10774
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4311
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0008575
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License Number State | CO
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