Provider Demographics
NPI:1730854381
Name:BROOKS, SONJI LOUISE
Entity type:Individual
Prefix:
First Name:SONJI
Middle Name:LOUISE
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 1:701 COOPER RD STE 11
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3800
Mailing Address - Country:US
Mailing Address - Phone:800-282-2208
Mailing Address - Fax:856-291-5079
Practice Address - Street 1:175 WHITE HORSE RD W STE B
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3673
Practice Address - Country:US
Practice Address - Phone:800-282-2208
Practice Address - Fax:856-291-5079
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08240501163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ815455655Medicaid
PA815455655Medicaid