Provider Demographics
NPI:1346621828
Name:BROOKS, ANGELIQUE (CNA)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:BROOKS
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 1:565 S MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:21
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6565
Mailing Address - Country:US
Mailing Address - Phone:224-830-4199
Mailing Address - Fax:
Practice Address - Street 1:565 S MARTIN LUTHER KING JR AVE
Practice Address - Street 2:21
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6565
Practice Address - Country:US
Practice Address - Phone:224-830-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker