Provider Demographics
NPI:1699264598
Name:BROOKS, JEFFREY
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20415 BALFOUR ST
Mailing Address - Street 2:APT 4
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225
Mailing Address - Country:US
Mailing Address - Phone:313-525-1568
Mailing Address - Fax:
Practice Address - Street 1:20415 BALFOUR ST
Practice Address - Street 2:APT 4
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225
Practice Address - Country:US
Practice Address - Phone:313-525-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703120285164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse