Provider Demographics
NPI:1134308208
Name:DOROTHY BROOKS R.N. FNP INC.
Entity Type:Organization
Organization Name:DOROTHY BROOKS R.N. FNP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-223-2021
Mailing Address - Street 1:1822 TRUMPET DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003
Mailing Address - Country:US
Mailing Address - Phone:530-241-1081
Mailing Address - Fax:530-223-3992
Practice Address - Street 1:3330 CHURN CREEK RD
Practice Address - Street 2:B3
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2532
Practice Address - Country:US
Practice Address - Phone:530-222-1492
Practice Address - Fax:530-223-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0109980Medicaid
CANP0109980Medicaid
CAP31583Medicare UPIN