Provider Demographics
NPI:1972040657
Name:BROOKS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BROOKS
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 1:608 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1548
Mailing Address - Country:US
Mailing Address - Phone:937-245-9070
Mailing Address - Fax:937-268-5266
Practice Address - Street 1:608 LELAND AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1548
Practice Address - Country:US
Practice Address - Phone:937-245-9070
Practice Address - Fax:937-268-5266
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide