Provider Demographics
NPI:1033541651
Name:BROOKS, CHANDRA STEPHANIE RAE
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:STEPHANIE RAE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 OLD MILL RD
Mailing Address - Street 2:P.O. BOX 283
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2623
Mailing Address - Country:US
Mailing Address - Phone:270-893-3900
Mailing Address - Fax:
Practice Address - Street 1:8312 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2623
Practice Address - Country:US
Practice Address - Phone:270-893-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider