Healthcare Provider Details

I. General information

NPI: 1043007073
Provider Name (Legal Business Name): LORENA LISBET BROOKS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 HALSEY ST APT 101
LENEXA KS
66216-3458
US

IV. Provider business mailing address

1535 W 15TH ST FL 3
LAWRENCE KS
66045-7608
US

V. Phone/Fax

Practice location:
  • Phone: 913-269-6620
  • Fax:
Mailing address:
  • Phone: 785-864-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: