Provider Demographics
NPI:1902116460
Name:MENZIE, BROOKE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:MENZIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 S RECKER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4205
Mailing Address - Country:US
Mailing Address - Phone:480-270-4376
Mailing Address - Fax:
Practice Address - Street 1:2152 S VINEYARD
Practice Address - Street 2:SUITE 131
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6871
Practice Address - Country:US
Practice Address - Phone:480-820-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7798445-1206363A00000X
AZ4760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant