Provider Demographics
NPI:1538925193
Name:MILLER, BROOKE BOWEN (RN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BOWEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9663
Mailing Address - Country:US
Mailing Address - Phone:912-531-6394
Mailing Address - Fax:
Practice Address - Street 1:6555 ABERCORN ST STE 221
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5714
Practice Address - Country:US
Practice Address - Phone:912-200-9818
Practice Address - Fax:912-200-9819
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse