Provider Demographics
NPI:1467014050
Name:HEIPLE, BROOKE (CRNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HEIPLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4327
Mailing Address - Country:US
Mailing Address - Phone:814-539-0257
Mailing Address - Fax:814-536-0963
Practice Address - Street 1:16 ROSE STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4327
Practice Address - Country:US
Practice Address - Phone:814-539-0257
Practice Address - Fax:814-536-0963
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020421363L00000X, 363LP2300X
PASO020421363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP020421Medicaid