Vananne, Brooke Neilly

Vananne, Brooke Neilly is an individual health care provider with primary practice located at 510 S Kingshighway Blvd Dept Radiology, Saint Louis MO 63110-1016. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Vananne, Brooke Neilly can be contacted via phone (314) 362-7200.

Contact Information

Primary practice address
510 S Kingshighway Blvd Dept Radiology Saint Louis MO 63110-1016
Phone: (314) 362-7200
Fax: (314) 747-4189
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2005030557 Missouri

Profile Details

NPI number 1699757955
LBN Legal business name Vananne, Brooke Neilly
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2005
Last updated May 9th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699757955 NPPES
Missouri MEDICAID 220050610

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