Provider Demographics
NPI:1003246380
Name:JUSTIS, BROOKE (CNP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:JUSTIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19000 ST JOES PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1478
Mailing Address - Country:US
Mailing Address - Phone:734-884-5200
Mailing Address - Fax:
Practice Address - Street 1:19000 ST JOES PKWY STE 160
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1478
Practice Address - Country:US
Practice Address - Phone:734-884-5200
Practice Address - Fax:734-466-5637
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704268691163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics