MEDICARE: RENDA RENEE BROOKS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372500000X	Chore Provider
2	376J00000X	Homemaker
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1992389613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENDA RENEE BROOKS

Provider Business Mailing Address
First Line	:	3821 BAY SHORE BND SE
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-6305
Country	:	US
Telephone Number	:	701-498-2577
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 BAY SHORE BND SE
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-6305
Country	:	US
Telephone Number	:	701-498-2577
Fax Number	:

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

Provider Enumeration Date	:	05/09/2021
Last Update Date	:	05/09/2021

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Directions to “ RENDA RENEE BROOKS ” Practice Location

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