Provider Demographics
NPI:1124545900
Name:BROOKS LINDSAY, SHAVONNE LATRICE (RN)
Entity Type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:LATRICE
Last Name:BROOKS LINDSAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MARINA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-7058
Mailing Address - Country:US
Mailing Address - Phone:443-652-2444
Mailing Address - Fax:
Practice Address - Street 1:222 MARINA VIEW CT
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-7058
Practice Address - Country:US
Practice Address - Phone:443-652-2444
Practice Address - Fax:443-652-2444
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214558163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management