Provider Demographics
NPI:1548922362
Name:VANHORN, BROOKS ALISA
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:ALISA
Last Name:VANHORN
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 1:2954 BUFFALO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-6911
Mailing Address - Country:US
Mailing Address - Phone:304-669-7886
Mailing Address - Fax:
Practice Address - Street 1:2954 BUFFALO CREEK RD
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385-6911
Practice Address - Country:US
Practice Address - Phone:304-669-7886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant