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General NPI Number Information
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NPI Number | 1861402224
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Entity Type | Individual
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Provider Name | JACQUELYN BONNIE BROOKS C-FNP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1641 E POLSTON AVE STE 101
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City | POST FALLS
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State | ID
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Zip | 83854-7852
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Country | US
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Telephone | 208-457-4208
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Fax | 208-457-4197
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Provider Business Mailing Address
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Address Line | 1593 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5326
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Country | US
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Telephone | 208-262-2300
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Fax | 208-262-2390
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61239730
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN368937
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71088
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License Number State | ID
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