Provider Demographics
NPI:1063130920
Name:WITHROW, BROOKE LEA
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEA
Last Name:WITHROW
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 1:3870 RUTLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-8124
Mailing Address - Country:US
Mailing Address - Phone:304-807-7570
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:4510 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4835
Practice Address - Country:US
Practice Address - Phone:304-965-9081
Practice Address - Fax:304-346-1860
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker