Provider Demographics
NPI:1427398148
Name:BROOKS-SLAUGHTER, BIANCA (LPN)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:
Last Name:BROOKS-SLAUGHTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25020 WOODLINE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4854
Mailing Address - Country:US
Mailing Address - Phone:216-297-5285
Mailing Address - Fax:440-735-3468
Practice Address - Street 1:25020 WOODLINE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-4854
Practice Address - Country:US
Practice Address - Phone:216-297-5285
Practice Address - Fax:440-735-3468
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 132837164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse