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General NPI Number Information
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NPI Number | 1396334637
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Entity Type | Individual
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Provider Name | DOMINIKA EUREKA BROOKS
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1155 MILL ST
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 LYNNDALE ST
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City | KENNETT
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State | MO
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Zip | 63857-4036
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Country | US
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Telephone | 901-504-0351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2019039596
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License Number State | MO
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