Healthcare Provider Details

I. General information

NPI: 1497773543
Provider Name (Legal Business Name): GENE E BROOKS APN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

1830 N NEWCASTLE AVE
CHICAGO IL
60707-3312
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4553
  • Fax: 773-880-8111
Mailing address:
  • Phone: 773-880-4000
  • Fax: 773-880-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-002198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: