Provider Demographics
NPI:1861150807
Name:LIPOW, BROOKE BERGER (MSN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BERGER
Last Name:LIPOW
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 MADRID AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2030
Mailing Address - Country:US
Mailing Address - Phone:208-651-0875
Mailing Address - Fax:
Practice Address - Street 1:709 MADRID AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2030
Practice Address - Country:US
Practice Address - Phone:208-651-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019341363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics