Basic Information
| Provider Information | |||||||||
| NPI: | 1235660242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUPPLACE | ||||||||
| FirstName: | BROOK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CRANMER | ||||||||
| OtherFirstName: | BROOK | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1091 MIDWAY DR | ||||||||
| Address2: | |||||||||
| City: | LINN CREEK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650521687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733466758 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1091 MIDWAY DR | ||||||||
| Address2: | |||||||||
| City: | LINN CREEK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650521687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733466758 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA0400X | 2004020214 | MO | Y | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | 163WG0600X | 2004020214 | MO | N | Nursing Service Providers | Registered Nurse | Gerontology |
No ID Information.