Healthcare Provider Details

I. General information

NPI: 1083397285
Provider Name (Legal Business Name): CHRISTIAN BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

IV. Provider business mailing address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-6685
  • Fax: 740-876-4005
Mailing address:
  • Phone: 740-354-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.163441.MEDS.IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: