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NPI Code Detail

MEDICARE: NICHOLE BROEKHUIS RN, BSN, CRNP

MEDICARE: NICHOLE BROEKHUIS RN, BSN, CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1-185641AL
2363LP0200XPediatric Nurse PractitionerAPRN.CNP0036317OH
3163W00000XRegistered NurseRN.423570OH
4363LP0200XPediatric Nurse Practitioner1-185641AL

General Provider Information

NPI Number : 1649851734
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLE BROEKHUIS RN, BSN, CRNP
Provider Business Mailing Address
First Line : 721 MIAMI CHAPEL RD
Second Line :
City : DAYTON
State : OH
Zip : 45417-4650
Country : US
Telephone Number : 937-901-2777
Fax Number :
Provider Business Practice Location Address
First Line : 721 MIAMI CHAPEL RD
Second Line :
City : DAYTON
State : OH
Zip : 45417-4650
Country : US
Telephone Number : 937-281-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 04/06/2026

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