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NPI Code Detail

MEDICARE: BROOKE MARISSA TUBBS

MEDICARE: BROOKE MARISSA TUBBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1114539137
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE MARISSA TUBBS
Provider Business Mailing Address
First Line : 5135 REDSTONE RD
Second Line :
City : SAINT LOUIS
State : MI
Zip : 48880-9602
Country : US
Telephone Number : 989-513-9360
Fax Number :
Provider Business Practice Location Address
First Line : 5135 REDSTONE RD
Second Line :
City : SAINT LOUIS
State : MI
Zip : 48880-9602
Country : US
Telephone Number : 989-513-9360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 08/21/2020

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Directions to “ BROOKE MARISSA TUBBS ” Practice Location

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