Individual
EBONIE BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
416 CRISWELL CT, WEST CARROLLTON, OH 45449-2470
(937) 952-4532
Mailing address
416 CRISWELL CT, WEST CARROLLTON, OH 45449-2470
(937) 952-4532
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN149-102
OH
Other
Enumeration date
02/18/2016
Last updated
02/18/2016
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