Provider Demographics
NPI:1689643991
Name:BROOKS, DENISE POLEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:POLEN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1820
Mailing Address - Country:US
Mailing Address - Phone:812-282-3410
Mailing Address - Fax:812-282-6178
Practice Address - Street 1:420 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1820
Practice Address - Country:US
Practice Address - Phone:812-282-3410
Practice Address - Fax:812-282-6178
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001986A363LA2200X
KY4543P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4543POtherARNP
IN71001986AOtherNP
P47173Medicare UPIN