Basic Information
| Provider Information | |||||||||
| NPI: | 1649318627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5617 WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724048859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | 8709323611 | ||||||||
| Practice Location | |||||||||
| Address1: | 5617 WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724048859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | 8709323611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | R65448 | AR | Y | Nursing Service Providers | Registered Nurse | Pediatrics | 373H00000X | N | Nursing Service Related Providers | Day Training/Habilitation Specialist |
No ID Information.