Provider Demographics
NPI:1447760178
Name:BROOKS, CHRISTIAN JOY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:JOY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:BEDORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1450 NW 6035
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-1450
Mailing Address - Country:US
Mailing Address - Phone:866-674-7933
Mailing Address - Fax:
Practice Address - Street 1:5775 WAYZATA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1222
Practice Address - Country:US
Practice Address - Phone:952-738-4477
Practice Address - Fax:952-543-6524
Is Sole Proprietor?:No
Enumeration Date:2017-10-08
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner