Provider Demographics
NPI:1962894907
Name:BROOKS, MARIA LYNN (RN BSN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-1424
Mailing Address - Country:US
Mailing Address - Phone:859-628-9968
Mailing Address - Fax:
Practice Address - Street 1:960 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1707
Practice Address - Country:US
Practice Address - Phone:859-572-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1129109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse