Provider Demographics
NPI:1932815354
Name:SMITH, BROOKE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:SMITH
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 1:4835 CORDELL AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3149
Mailing Address - Country:US
Mailing Address - Phone:720-774-4171
Mailing Address - Fax:
Practice Address - Street 1:4835 CORDELL AVE APT 308
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3149
Practice Address - Country:US
Practice Address - Phone:720-774-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty