Provider Demographics
NPI:1588813539
Name:BROOKS, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:FOLLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5765 PEASE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9369
Mailing Address - Country:US
Mailing Address - Phone:585-755-8953
Mailing Address - Fax:
Practice Address - Street 1:5765 PEASE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9369
Practice Address - Country:US
Practice Address - Phone:585-755-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267696164W00000X
NY701781163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse