Vananne, Brooke Neilly
Vananne, Brooke Neilly is an individual health care provider with primary practice located at 510 S Kingshighway Blvd Dept Radiology, Saint Louis MO 63110-1016. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Vananne, Brooke Neilly can be contacted via phone (314) 362-7200.Contact Information
Primary practice address
510 S Kingshighway Blvd Dept Radiology
Saint Louis MO 63110-1016
Phone: (314) 362-7200
Fax: (314) 747-4189
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 2005030557 | Missouri |
Profile Details
| NPI number | 1699757955 |
|---|---|
| LBN Legal business name | Vananne, Brooke Neilly |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 14th, 2005 |
| Last updated | May 9th, 2024 - about 7 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699757955 | NPPES |
| Missouri | MEDICAID | 220050610 |
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