| Doctor Name: | BROOKE NICOLE DEWEESE |
| NPI Number: | 1174867279 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | PA.0003584 |
| Business Practice Address: | 121 S. Crescent Drive Pueblo West, CO - 810075433 |
| Business Phone Number: | 7195957575 |
| Business Fax Number: | 7192882799 |
| Mailing Address: | Po Box 560825, DENVER |
| State: | CO |
| Postal Code: | 802560825 |
| Phone Number: | 7195957580 |
| Fax Number: | 7195450176 |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA.0003584 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |