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Individual

MRS. WANTINA WYNETTE BROOKS-ROACH

Active
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Individual

MRS. WANTINA WYNETTE BROOKS-ROACH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCPM

Taxonomy

Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
9000017
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9000017
KENTUCKY MIDWIFE LICENSE
KY
Enumeration date
03/05/2007
Last updated
11/27/2020
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