Provider Demographics
NPI:1649751017
Name:BROOKS, LIZABETH ANN
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W CENTRAL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3446
Mailing Address - Country:US
Mailing Address - Phone:406-539-3694
Mailing Address - Fax:
Practice Address - Street 1:404 W CENTRAL AVE APT 2
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3446
Practice Address - Country:US
Practice Address - Phone:406-539-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion