Provider Demographics
NPI:1447458575
Name:HOSSLE, BROOKE LARAE (BSN RN)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LARAE
Last Name:HOSSLE
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:500 E 9TH ST
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0662
Mailing Address - Country:US
Mailing Address - Phone:605-842-1465
Mailing Address - Fax:605-842-2366
Practice Address - Street 1:500 E 9TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-0662
Practice Address - Country:US
Practice Address - Phone:605-842-1465
Practice Address - Fax:605-842-2366
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR034983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse