MEDICARE: LAURA L BROOKS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	2004033443	MO

General Provider Information

NPI Number	:	1215527080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L BROOKS RN

Provider Business Mailing Address
First Line	:	1173 N PRICE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2301
Country	:	US
Telephone Number	:	314-569-5830
Fax Number	:	314-569-9026

Provider Business Practice Location Address
First Line	:	1173 N PRICE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2301
Country	:	US
Telephone Number	:	314-569-5830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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