MEDICARE: BROOKE KATHARINE PURPERO BSN RN

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
1	163WS0200X	School Registered Nurse	263475	SC

General Provider Information

NPI Number	:	1740065994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE KATHARINE PURPERO BSN RN

Provider Business Mailing Address
First Line	:	1999 SINGLEY ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 SINGLEY ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5014
Country	:	US
Telephone Number	:	843-529-4616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	09/11/2023

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