Provider Demographics
NPI:1073399960
Name:LAESSIG, BROOKE ANNA (NP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNA
Last Name:LAESSIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9287 TWENTY MILE RD UNIT 404
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6091
Mailing Address - Country:US
Mailing Address - Phone:720-384-5156
Mailing Address - Fax:
Practice Address - Street 1:2352 MEADOWS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8419
Practice Address - Country:US
Practice Address - Phone:720-455-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999089-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily