Provider Demographics
NPI:1134996887
Name:EDWARDS, BROOK MAKALA JANE
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:MAKALA JANE
Last Name:EDWARDS
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 1:149 LONESOME CEDAR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-5979
Mailing Address - Country:US
Mailing Address - Phone:304-926-4938
Mailing Address - Fax:
Practice Address - Street 1:149 LONESOME CEDAR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-5979
Practice Address - Country:US
Practice Address - Phone:304-926-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant