Provider Demographics
NPI:1497506422
Name:GUSHEA, BROOKE ALEXA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXA
Last Name:GUSHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7178 SOUTH RECOVERY ROAD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231
Mailing Address - Country:US
Mailing Address - Phone:209-468-6013
Mailing Address - Fax:
Practice Address - Street 1:7178 SOUTH RECOVERY ROAD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231
Practice Address - Country:US
Practice Address - Phone:209-468-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker