Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APN00359 | NV |
NPI | 1023338738 |
---|---|
Provider Name | Michaela Susan Brooks |
First Address | Las Vegas, NV 89104-3022 |
Second Address | Las Vegas, NV 89104-3022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 03/06/2010 |