Provider Demographics
NPI:1578222931
Name:BROOKS, STEPHANIE (RN, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HAMPTON BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9010
Mailing Address - Country:US
Mailing Address - Phone:910-750-5692
Mailing Address - Fax:
Practice Address - Street 1:220 HAMPTON BLUFF RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9010
Practice Address - Country:US
Practice Address - Phone:910-750-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225393163WC1500X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult