Brooks, Dustin
Brooks, Dustin is an sole proprietor health care provider with primary practice located at 127 Stewart St , East Peoria IL 61611-2613. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Brooks, Dustin can be contacted via phone (309) 678-7422.Contact Information
Primary practice address
127 Stewart St
East Peoria IL 61611-2613
Phone: (309) 678-7422
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 209019082 | Illinois |
Profile Details
| NPI number | 1568017333 |
|---|---|
| LBN Legal business name | Brooks, Dustin |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 7th, 2019 |
| Last updated | Mar 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568017333 | NPPES |
| Illinois | MEDICAID | 209019082 |
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