Provider Demographics
NPI:1952305633
Name:BROOKS, JENNIFER MARY (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 STONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-330-9105
Mailing Address - Fax:804-287-6119
Practice Address - Street 1:9101 STONY POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-330-9105
Practice Address - Fax:804-287-6119
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165656367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008955590Medicaid
VA008955590Medicaid
VA430080369Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER