Healthcare Provider Details

I. General information

NPI: 1801220884
Provider Name (Legal Business Name): RACHEL J BROOKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BIRCHARD AVE
FREMONT OH
43420-2967
US

IV. Provider business mailing address

410 BIRCHARD AVE
FREMONT OH
43420-2967
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-3869
  • Fax: 419-334-8546
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.14958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: