| Doctor Name: | MRS. BROOKE NAYAK |
| NPI Number: | 1003246380 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N., C.P.N.P.-P.C. |
| License Number: | 4704268691 |
| Business Practice Address: | 15255 Northline Rd Southgate, MI - 481952487 |
| Business Phone Number: | 7342853090 |
| Business Fax Number: | |
| Mailing Address: | 15255 Northline Rd, SOUTHGATE |
| State: | MI |
| Postal Code: | 481952487 |
| Phone Number: | 7342853090 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2013 |
| NPI Last Update Date: | 11/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4704268691 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |