Provider Demographics
NPI:1700516523
Name:BROOKS, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
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 1:12245 S COUNTY ROAD 1000 E
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:IN
Mailing Address - Zip Code:46932-8610
Mailing Address - Country:US
Mailing Address - Phone:765-210-3068
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1983
Practice Address - Country:US
Practice Address - Phone:765-236-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28217866A364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care