Provider Demographics
NPI:1700123783
Name:FISHER, BROOKE A (CNA, QMAP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNA, QMAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12366 W NEVADA PL APT 107
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3228
Mailing Address - Country:US
Mailing Address - Phone:308-289-0991
Mailing Address - Fax:
Practice Address - Street 1:12366 W NEVADA PL APT 107
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3228
Practice Address - Country:US
Practice Address - Phone:308-289-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO700713376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide