Basic Information
| Provider Information | |||||||||
| NPI: | 1578207346 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RC BROOKS CONSULTING LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BLUEPRINT DIABETES MANAGEMENT & CONSULTING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 HAZARD AVE STE 23 | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609514140 | ||||||||
| FaxNumber: | 8603008465 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 TAVERNER RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060951749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609514140 | ||||||||
| FaxNumber: | 8603008465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2022 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | RUSHICKAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8609514140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Diabetes Educator | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.