Provider Demographics
NPI:1205416849
Name:BROOKS, DALLRIE MARIE (STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:DALLRIE
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-6458
Mailing Address - Country:US
Mailing Address - Phone:225-603-9767
Mailing Address - Fax:
Practice Address - Street 1:3543 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-6458
Practice Address - Country:US
Practice Address - Phone:225-603-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator