Provider Demographics
NPI:1700420775
Name:BROOKS, GENEVIEVE L (MACOM)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 24TH AVE NW APT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5864
Mailing Address - Country:US
Mailing Address - Phone:206-941-2367
Mailing Address - Fax:
Practice Address - Street 1:425 N 36TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8630
Practice Address - Country:US
Practice Address - Phone:360-209-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAACUP.AC.60990154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist