Provider Demographics
NPI:1861413775
Name:MCBROOM, BRENDA (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 LA POSTA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1862
Mailing Address - Country:US
Mailing Address - Phone:915-491-3555
Mailing Address - Fax:
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-532-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX574686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y1635OtherBCBS
TX574686OtherNURSE PRACTITIONERS