Brook Lynn Dake, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Newberry, MI
NPI 1780169375 · NPPES record last updated Sep 28, 2018
Key facts
- NPI
- 1780169375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704322308 (MI)
- Practice address
- 502 W Harrie St
Newberry, MI 49868-1209 - Phone
- (906) 293-9200
- NPI assigned
- Sep 28, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Helen Newberry Joy Hospital
Practice addresses (Care Compare)
502 W Harrie St
Newberry, MI 49868-1209
Phone (906) 293-9200
Hospital & facility affiliations
- Helen Newberry Joy Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181101001380 | MI | Practitioner - Nurse Practitioner | 6507119989 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704322308 | MI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Helen Newberry Joy Hospital & Healthcare Center | Current |
Accepting new patients | |
| Helen Newberry Joy Hospital & Healthcare Center | Current | Accepting new patients | |
| Helen Newberry Joy Hospital & Healthcare Center | Current | Accepting new patients |
Locations
502 W Harrie St
Newberry, MI 49868
Phone (906) 293-9131
Interoperability endpoints
- bdake128864@mymichiganhealth.midirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704322308 | MI | Yes |
Addresses
Primary practice location
502 W Harrie St
Newberry, MI 49868-1209
Mailing address
315 W Victory Way
Newberry, MI 49868-1647
Phone (906) 450-0729
Other names
- Brook Lynn Derusha
Other providers in Newberry, MI
- Jessica Bufford
- Chippewa Dialysis Services
- County of Luce
- Quin Curley
- Michelle Zang Curtis-Nutkins
- Derek James Dake
- Dale W Muth OD PLLC
- Dale W Muth OD PLLC
- Denise Magdalene Danaher
- Christine Elizabeth Deangelo
All providers in Newberry, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.