Provider Demographics
NPI:1952469736
Name:BROUK, CHRISTINE LYNN (RN,BSN,CNOR,RNFA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LYNN
Last Name:BROUK
Suffix:
Gender:F
Credentials:RN,BSN,CNOR,RNFA
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 867166
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-7166
Mailing Address - Country:US
Mailing Address - Phone:214-566-4574
Mailing Address - Fax:469-241-9096
Practice Address - Street 1:4564 BENTLEY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7151
Practice Address - Country:US
Practice Address - Phone:214-566-4574
Practice Address - Fax:469-241-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676742163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37HTOtherBCBS