Provider Demographics
NPI:1841588563
Name:BROOKS, JACQUELENE PATRICE (LVN)
Entity Type:Individual
Prefix:
First Name:JACQUELENE
Middle Name:PATRICE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 MAY ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-2318
Mailing Address - Country:US
Mailing Address - Phone:916-873-7745
Mailing Address - Fax:
Practice Address - Street 1:4443 MAY ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2318
Practice Address - Country:US
Practice Address - Phone:916-873-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN222706164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse