Provider Demographics
NPI:1831968825
Name:BROCK, NNKESIA AMABELLE (DOULA)
Entity type:Individual
Prefix:
First Name:NNKESIA
Middle Name:AMABELLE
Last Name:BROCK
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ANOKA PL
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-2502
Mailing Address - Country:US
Mailing Address - Phone:781-731-2261
Mailing Address - Fax:
Practice Address - Street 1:10 ANOKA PL
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2502
Practice Address - Country:US
Practice Address - Phone:781-731-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula