Provider Demographics
NPI:1205401544
Name:BROOKS, ANGELA DAWN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
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:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:GLEN FORK
Mailing Address - State:WV
Mailing Address - Zip Code:25845-0402
Mailing Address - Country:US
Mailing Address - Phone:304-923-4485
Mailing Address - Fax:
Practice Address - Street 1:176 GARDEN ST
Practice Address - Street 2:
Practice Address - City:GLEN FORK
Practice Address - State:WV
Practice Address - Zip Code:25845
Practice Address - Country:US
Practice Address - Phone:304-923-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant