Basic Information
Provider Information
NPI: 1659877827
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNOP
FirstName: BROOKE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: POSEGATE
OtherFirstName: BROOKE
OtherMiddleName: L
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1200 PLEASANT STREET
Address2: SOUTH 2 ROOM 236
City: DES MOINES
State: IA
PostalCode: 503091406
CountryCode: US
TelephoneNumber: 5152416228
FaxNumber: 5152418685
Practice Location
Address1: 3714 INGERSOLL AVE
Address2:  
City: DES MOINES
State: IA
PostalCode: 503123411
CountryCode: US
TelephoneNumber: 5153096011
FaxNumber: 5153096014
Other Information
ProviderEnumerationDate: 04/04/2018
LastUpdateDate: 04/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XB137679IAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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