Individual
KENDRA DANELLE BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 933-4380
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-4380
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003722
MI
363AM0700X
Medical Physician Assistant
5601003722
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601003722
STATE LICENSE
MI
Enumeration date
08/05/2007
Last updated
07/28/2023
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