Healthcare Provider Details

I. General information

NPI: 1952469736
Provider Name (Legal Business Name): CHRISTINE LYNN BROUK RN,BSN,CNOR,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4564 BENTLEY DR
PLANO TX
75093-7151
US

IV. Provider business mailing address

PO BOX 867166
PLANO TX
75086-7166
US

V. Phone/Fax

Practice location:
  • Phone: 214-566-4574
  • Fax: 469-241-9096
Mailing address:
  • Phone: 214-566-4574
  • Fax: 469-241-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number676742
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: