Provider Demographics
NPI:1407278872
Name:KELLY-BROOKS, D'NETRA (LPN)
Entity Type:Individual
Prefix:
First Name:D'NETRA
Middle Name:
Last Name:KELLY-BROOKS
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 1:120 LOZIER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2522
Mailing Address - Country:US
Mailing Address - Phone:585-214-9188
Mailing Address - Fax:
Practice Address - Street 1:120 LOZIER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2522
Practice Address - Country:US
Practice Address - Phone:585-214-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313932164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse