Provider Demographics
NPI:1598795551
Name:BROOKSHIRE, CYNTHIA L (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BROOKSHIRE
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 1:715 WARE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1723
Mailing Address - Country:US
Mailing Address - Phone:912-449-2032
Mailing Address - Fax:912-449-0409
Practice Address - Street 1:715 WARE ST
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1723
Practice Address - Country:US
Practice Address - Phone:912-449-2032
Practice Address - Fax:912-449-0409
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN11730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse