Provider Demographics
NPI:1457169682
Name:MADDOX, BROOKE JORDAN
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:JORDAN
Last Name:MADDOX
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 1:500 121ST PL NE APT C2
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3175
Mailing Address - Country:US
Mailing Address - Phone:214-558-3017
Mailing Address - Fax:
Practice Address - Street 1:500 121ST PL NE APT C2
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3175
Practice Address - Country:US
Practice Address - Phone:214-558-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula