Individual
KRISTEN LYNN BROKAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3815 HARRISON AVE, ROCKFORD, IL 61108-7631
(815) 391-1000
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209-016810
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-016810
APN
IL
Enumeration date
12/06/2017
Last updated
06/16/2018
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