MEDICARE: MS. MARLINA M BROOKS NURSE

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	163W00000X	Registered Nurse	RN00135852	WA

General Provider Information

NPI Number	:	1639155906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLINA M BROOKS NURSE

Provider Business Mailing Address
First Line	:	141 E LYRE RIVER RD
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-8618
Country	:	US
Telephone Number	:	360-928-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 E LYRE RIVER RD
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-8618
Country	:	US
Telephone Number	:	360-928-3257
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/08/2007

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