Healthcare Provider Details

I. General information

NPI: 1659252880
Provider Name (Legal Business Name): AUDREY BROOKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 UNION LAKE RD STE 100
COMMERCE TOWNSHIP MI
48382-3583
US

IV. Provider business mailing address

2630 UNION LAKE RD STE 100
COMMERCE TOWNSHIP MI
48382-3583
US

V. Phone/Fax

Practice location:
  • Phone: 248-360-1200
  • Fax: 248-360-6182
Mailing address:
  • Phone: 248-360-1200
  • Fax: 248-360-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704364466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: