Basic Information
| Provider Information | |||||||||
| NPI: | 1841883865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | WHITNEY | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3383 N WINDY RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478829413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122408571 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3495 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478025501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126451892 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2021 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 28207489A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.