Individual
MRS. AMY JO BROKAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
43 KENNEDY DR, CALDWELL, OH 43724-9004
(740) 732-5211
(740) 732-4175
Mailing address
43 KENNEDY DR, CALDWELL, OH 43724-9004
(740) 732-5211
(740) 732-4175
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
119768-MEDS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0136187
—
OH
Enumeration date
07/28/2015
Last updated
07/28/2015
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