Provider Demographics
NPI:1013256783
Name:SUKHANOV, BROOKE LYNNE (CLD)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LYNNE
Last Name:SUKHANOV
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 VILLAGE OAKS CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-716-3616
Mailing Address - Fax:
Practice Address - Street 1:1355 VILLAGE OAKS CIR APT 4
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-716-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13068072374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula