Provider Demographics
NPI:1275927063
Name:THIROUX, BROOKE (LPN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:THIROUX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 LAURELTON RD
Mailing Address - Street 2:
Mailing Address - City:IRONDEQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4511
Mailing Address - Country:US
Mailing Address - Phone:315-484-8173
Mailing Address - Fax:
Practice Address - Street 1:635 LAURELTON RD
Practice Address - Street 2:
Practice Address - City:IRONDEQUOIT
Practice Address - State:NY
Practice Address - Zip Code:14609-4511
Practice Address - Country:US
Practice Address - Phone:315-484-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295568164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse