Provider Demographics
NPI:1194518886
Name:COLEBROOKE, BRANDIE ELISE
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:ELISE
Last Name:COLEBROOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:ELISE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1213 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3548
Mailing Address - Country:US
Mailing Address - Phone:760-207-8969
Mailing Address - Fax:
Practice Address - Street 1:1213 ILLINI DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3548
Practice Address - Country:US
Practice Address - Phone:760-207-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program