Healthcare Provider Details

I. General information

NPI: 1407921190
Provider Name (Legal Business Name): ALICE BRITTAIN BROOKS RM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 BURNT MILL RD
WILLMINGTON NC
28403
US

IV. Provider business mailing address

3237 S COLLEGE RD
WILMINGTON NC
28412
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-5817
  • Fax: 910-251-2652
Mailing address:
  • Phone: 910-791-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number036838
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: