Provider Demographics
NPI:1104601079
Name:BROOK, CATHY (COMMUNITY HEALTH)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BROOK
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-1764
Mailing Address - Country:US
Mailing Address - Phone:218-444-9038
Mailing Address - Fax:
Practice Address - Street 1:206 MINNESOTA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4027
Practice Address - Country:US
Practice Address - Phone:218-444-9038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker