Provider Demographics
NPI:1558633768
Name:BROOKS, MEGAN BETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BETH
Last Name: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 1:2094 HATTERAS CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7240
Mailing Address - Country:US
Mailing Address - Phone:937-422-9265
Mailing Address - Fax:
Practice Address - Street 1:2094 HATTERAS CT
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7240
Practice Address - Country:US
Practice Address - Phone:937-422-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128933IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse