Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | TP004741B | PA |
NPI | 1881686665 |
---|---|
Provider Name | Shirlee Marie Drayton-Brooks |
First Address | Swedesboro, NJ 08085-3319 |
Second Address | Philadelphia, PA 19142-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 28/04/2010 |