Provider Demographics
NPI:1588352272
Name:BROOKS, BETH A (PHD, RN)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 W THORNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6005
Mailing Address - Country:US
Mailing Address - Phone:773-612-7224
Mailing Address - Fax:
Practice Address - Street 1:4217 W THORNDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6005
Practice Address - Country:US
Practice Address - Phone:773-612-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-224023163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator