Provider Demographics
NPI:1760029920
Name:BROOKS, MONIQUE RITA (CRNP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RITA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2120
Mailing Address - Country:US
Mailing Address - Phone:267-992-8951
Mailing Address - Fax:
Practice Address - Street 1:230 W WASHINGTON SQ FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021231363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care