Provider Demographics
NPI:1932759008
Name:FRIES, BROOKE (RN)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:FRIES
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 1:9100 WHITE BLUFF RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4670
Mailing Address - Country:US
Mailing Address - Phone:912-355-6472
Mailing Address - Fax:
Practice Address - Street 1:9100 WHITE BLUFF RD STE 603
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4674
Practice Address - Country:US
Practice Address - Phone:912-355-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279883163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy