Provider Demographics
NPI:1558650937
Name:BROOKS, ANGELA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
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 1:4521 PRONGHORN WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-8923
Mailing Address - Country:US
Mailing Address - Phone:925-759-5169
Mailing Address - Fax:
Practice Address - Street 1:4521 PRONGHORN WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-8923
Practice Address - Country:US
Practice Address - Phone:925-759-5169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537695163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology