NPI 1467170472 · live from the CMS NPI Registry
Nicole Brockman, PNP, MSN, BSN
Nurse Practitioner, Pediatrics in Saint Louis, MO. National Provider Identifier 1467170472, active.
NPI record
| NPI | 1467170472 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 4400 Clayton Ave, Saint Louis, MO 63110 |
| Practice phone | 314-432-3600 |
| Mailing address | 45 Fox Mdws, Saint Louis, MO 63127 |
| Enumerated | August 16, 2022 |
| Last updated | August 16, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 2021009743 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.