Provider Demographics
NPI:1770011587
Name:JOAQUIN, BROOKE MERCEDES
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MERCEDES
Last Name:JOAQUIN
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-0366
Mailing Address - Country:US
Mailing Address - Phone:360-249-8421
Mailing Address - Fax:360-249-8545
Practice Address - Street 1:315 W MARCY AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3618
Practice Address - Country:US
Practice Address - Phone:360-249-8421
Practice Address - Fax:360-249-8545
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60755009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist