Provider Demographics
NPI:1215601737
Name:MCBROOM, JONETTA MICHELLE (CNA)
Entity Type:Individual
Prefix:
First Name:JONETTA
Middle Name:MICHELLE
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 FERRELL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3787
Mailing Address - Country:US
Mailing Address - Phone:870-351-3690
Mailing Address - Fax:
Practice Address - Street 1:1005 FERRELL ST APT 3
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3787
Practice Address - Country:US
Practice Address - Phone:870-351-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide