Provider Demographics
NPI:1578654679
Name:BROOKS, DELICIA ANN (NP)
Entity type:Individual
Prefix:
First Name:DELICIA
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 GRANADA CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-6201
Mailing Address - Country:US
Mailing Address - Phone:317-924-9108
Mailing Address - Fax:
Practice Address - Street 1:8777 PURDUE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3125
Practice Address - Country:US
Practice Address - Phone:317-755-4017
Practice Address - Fax:317-755-4012
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28127488A163WW0101X
IN71001596A163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200802560Medicaid
INQ61390Medicare UPIN
IN200802560Medicaid