Individual
BROOKE BALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
203 CONSTITUTION DR SW # B, POPLAR GROVE, IL 61065-8729
(815) 355-5369
Mailing address
203 CONSTITUTION DR SW # B, POPLAR GROVE, IL 61065-8729
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/29/2020
Last updated
04/29/2020
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