Individual
SAGE E BROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
325 HAWTHORNE LN, CHARLOTTE, NC 28204-2535
(704) 973-2106
(704) 973-2395
Mailing address
PO BOX 601067, CHARLOTTE, NC 28260-1067
(704) 512-5100
(704) 512-5101
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
126103
NC
367A00000X
Advanced Practice Midwife
Primary
104
NC
367A00000X
Advanced Practice Midwife
123103
NC
367A00000X
Advanced Practice Midwife
126103
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104
NC CNM
NC
01
—
126103
RN LICENSE
NC
05
—
1952398729
—
NC
05
—
7002111
—
NC
05
—
MW0167
—
SC
Enumeration date
10/05/2005
Last updated
10/25/2020
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