Individual
BROOK ASHLEE GRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18586 5TH ST, BELOIT, OH 44609-9799
(330) 938-3333
(330) 938-9375
Mailing address
2242 PARKWAY BLVD, ALLIANCE, OH 44601-4650
(330) 823-7855
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2565
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1076079
PA CERTIFICATION
OH
01
—
2565
STATE MEDICAL BOARD
OH
Enumeration date
02/09/2007
Last updated
11/06/2009
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