Basic Information
| Provider Information | |||||||||
| NPI: | 1275003113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | CATHLEEN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2933 GLENVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480733171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863444645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 N TELEGRAPH RD # 32 | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483411032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484513742 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2018 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 4704236880 | MI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.