Provider Demographics
NPI:1730916164
Name:NELLER, BROOKE (RN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:NELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CROSSMAN RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-2117
Mailing Address - Country:US
Mailing Address - Phone:860-912-0610
Mailing Address - Fax:
Practice Address - Street 1:51 CROSSMAN RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:CT
Practice Address - Zip Code:06756-2117
Practice Address - Country:US
Practice Address - Phone:860-912-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse