Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP143649 | TX |
NPI | 1033754122 |
---|---|
Provider Name | Brooke Rockafellow Breedlove |
First Address | Dallas, TX 75284-4658 |
Second Address | Marble Falls, TX 78654-5866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2019 |
Last Update Date | 03/12/2021 |