Provider Demographics
NPI:1851671366
Name:BROOKS, CASSANDRA LYNNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LYNNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 TOWNSHIP ROAD 199
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9589
Mailing Address - Country:US
Mailing Address - Phone:419-560-1997
Mailing Address - Fax:
Practice Address - Street 1:6310 TOWNSHIP ROAD 199
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9589
Practice Address - Country:US
Practice Address - Phone:419-560-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.144275-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse