Provider Demographics
NPI:1457917676
Name:BROOKS, CRYSTAL JILL (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JILL
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:ARROWSIC
Mailing Address - State:ME
Mailing Address - Zip Code:04530-7410
Mailing Address - Country:US
Mailing Address - Phone:207-449-8788
Mailing Address - Fax:207-621-4834
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4834
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER056361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse