Provider Demographics
NPI:1316341118
Name:BROOKS, BRANDI ROCHELLE
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ROCHELLE
Last Name:BROOKS
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 1:5576 CY YOUNG DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5621
Mailing Address - Country:US
Mailing Address - Phone:702-722-2495
Mailing Address - Fax:702-650-2184
Practice Address - Street 1:3281 N DECATUR BLVD
Practice Address - Street 2:280
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3263
Practice Address - Country:US
Practice Address - Phone:702-444-6082
Practice Address - Fax:702-650-2184
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator