MEDICARE: DR. BETH A BROOKS PHD, 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	163WA2000X	Administrator Registered Nurse	041-224023	IL

General Provider Information

NPI Number	:	1588352272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH A BROOKS PHD, RN

Provider Business Mailing Address
First Line	:	4217 W THORNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6005
Country	:	US
Telephone Number	:	773-612-7224
Fax Number	:

Provider Business Practice Location Address
First Line	:	4217 W THORNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6005
Country	:	US
Telephone Number	:	773-612-7224
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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