Provider Demographics
NPI:1679309140
Name:BROOKS, NORMA MERICA
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:MERICA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 VALLEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-8338
Mailing Address - Country:US
Mailing Address - Phone:803-542-4127
Mailing Address - Fax:
Practice Address - Street 1:1218 VALLEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8338
Practice Address - Country:US
Practice Address - Phone:803-542-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33284164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse