Provider Demographics
NPI:1376687756
Name:BROOKS, SANDRA DENISE (R,N,)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DENISE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:R,N,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 HINSEL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7717
Mailing Address - Country:US
Mailing Address - Phone:914-751-9254
Mailing Address - Fax:
Practice Address - Street 1:2983 HINSEL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7717
Practice Address - Country:US
Practice Address - Phone:914-751-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH179125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2118934Medicaid