Provider Demographics
NPI:1033442686
Name:BROOKS, ANNETTE RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RENEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 OLD STREET RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1200
Mailing Address - Country:US
Mailing Address - Phone:603-924-4671
Mailing Address - Fax:
Practice Address - Street 1:454 OLD STREET RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1200
Practice Address - Country:US
Practice Address - Phone:603-924-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN183163363LA2200X
NH032446-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30348959Medicaid
NH002275301OtherMEDICARE PTAN