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Brooke Southivong
NPI 1467887406 · on the registry since 2013
Practice
- Address
- 884 Beal Brook Pass
Fort Wayne, IN 46814 - Phone
- (260) 479-0828
Registry record
- Primary taxonomy
- 224Z00000X
224Z00000X
- Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2014-02-20
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana