Provider Demographics
NPI:1558186791
Name:BROOKS, ANDREW DAVID (RN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:BROOKS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W LIL BEN TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-7014
Mailing Address - Country:US
Mailing Address - Phone:907-482-0366
Mailing Address - Fax:
Practice Address - Street 1:400 W ELM AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1564
Practice Address - Country:US
Practice Address - Phone:928-773-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ284613163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool