Individual
BROOKE A RAVEENDRANATH
Active
Individual
BROOKE A RAVEENDRANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
381788
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000420465001
BSNENY
NY
05
—
02848268
—
NY
01
—
091210000047
FIDELIS
NY
01
—
143259
GHI-HMO
NY
01
—
3010992
MVP HEALTHCARE
NY
Enumeration date
01/22/2007
Last updated
06/09/2021
Update your record
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