Provider Demographics
NPI:1538482948
Name:BROOKINS, DEANNA LYNN
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LYNN
Last Name:BROOKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:LYNN
Other - Last Name:MATTEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2420 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-3016
Mailing Address - Country:US
Mailing Address - Phone:262-880-0719
Mailing Address - Fax:
Practice Address - Street 1:2420 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-3016
Practice Address - Country:US
Practice Address - Phone:262-880-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312293-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse