Provider Demographics
NPI:1295212934
Name:MCBROOM, HEIDI (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-2509
Mailing Address - Country:US
Mailing Address - Phone:713-294-4221
Mailing Address - Fax:
Practice Address - Street 1:31 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-2509
Practice Address - Country:US
Practice Address - Phone:713-294-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX937470163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX937470OtherTEXAS BOARD OF NURSING