Basic Information
| Provider Information | |||||||||
| NPI: | 1033192984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKE | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 PACIFIC AVENUE | ||||||||
| Address2: | COMMUNITY HEALTH CARE | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537221540 | ||||||||
| FaxNumber: | 2537221546 | ||||||||
| Practice Location | |||||||||
| Address1: | 10510 GRAVELLY LAKE DRIVE | ||||||||
| Address2: | COMMUNITY HEALTH CARE | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534714553 | ||||||||
| FaxNumber: | 2534745395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD26206 | OR | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD00027007 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 023287 | 05 | OR | MEDICAID | 807312600 | 05 | ID | MEDICAID |