Provider Demographics
NPI:1124665500
Name:ANELICK, BROOKLYNN COLLEEN
Entity type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:COLLEEN
Last Name:ANELICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKLYNN
Other - Middle Name:COLLEEN
Other - Last Name:GEYGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2190 LUNDYS LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9543
Mailing Address - Country:US
Mailing Address - Phone:614-975-9023
Mailing Address - Fax:
Practice Address - Street 1:2190 LUNDYS LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9543
Practice Address - Country:US
Practice Address - Phone:614-975-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide