Provider Demographics
NPI:1184841363
Name:BROOKOVER, MARTHA J (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:BROOKOVER
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 1:1005 UNION SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2084
Mailing Address - Country:US
Mailing Address - Phone:615-206-1100
Mailing Address - Fax:615-206-9742
Practice Address - Street 1:1005 UNION SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2084
Practice Address - Country:US
Practice Address - Phone:615-206-1100
Practice Address - Fax:615-206-9742
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31652163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31652OtherRN