| Doctor Name: | BROOKE D ETHRIDGE |
| NPI Number: | 1063852564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 113466 |
| Business Practice Address: | 1105 Sunset Ave Manhattan, KS - 665023761 |
| Business Phone Number: | 7855327755 |
| Business Fax Number: | 7855326627 |
| Mailing Address: | 1105 Sunset Ave, MANHATTAN |
| State: | KS |
| Postal Code: | 665023761 |
| Phone Number: | 7855327755 |
| Fax Number: | 7855326627 |
| NPI Enumeration Date: | 06/28/2013 |
| NPI Last Update Date: | 06/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1400X |
| License Number: | 113466 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | College Health |
| Taxonomy Definition: | |