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General NPI Number Information
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NPI Number | 1942904149
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Entity Type | Individual
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Provider Name | BROOKE DANIELLE BRYAN WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3330
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Country | US
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Telephone | 470-325-1539
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Fax | 770-339-8505
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Provider Business Mailing Address
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Address Line | 2326 BRITT ST
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City | GRAYSON
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State | GA
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Zip | 30017-1772
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Country | US
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Telephone | 678-956-4040
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN234127
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License Number State | GA
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