Provider Demographics
NPI:1477102135
Name:BROOKS, MELISSA JOAN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 JESSI LN
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6759
Mailing Address - Country:US
Mailing Address - Phone:937-572-3190
Mailing Address - Fax:
Practice Address - Street 1:2064 JESSI LN
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-6759
Practice Address - Country:US
Practice Address - Phone:937-572-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.284245OtherRN LICENSE