Provider Demographics
NPI:1366124471
Name:SHEETS, BROOKE MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MICHELLE
Last Name:SHEETS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19175 W KELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:NE
Mailing Address - Zip Code:69143-4350
Mailing Address - Country:US
Mailing Address - Phone:308-529-3762
Mailing Address - Fax:
Practice Address - Street 1:19175 W KELLEY AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:NE
Practice Address - Zip Code:69143-4350
Practice Address - Country:US
Practice Address - Phone:308-529-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse