Provider Demographics
NPI:1437513140
Name:BROCKELMAN, LAURIE (APRN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BROCKELMAN
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 1:462 RTE 119 EAST
Mailing Address - Street 2:
Mailing Address - City:FITZ;WILLIAM
Mailing Address - State:NH
Mailing Address - Zip Code:03447-3149
Mailing Address - Country:US
Mailing Address - Phone:603-585-6788
Mailing Address - Fax:
Practice Address - Street 1:462 ROUTE 119 EAST
Practice Address - Street 2:
Practice Address - City:FITZWILLIAM
Practice Address - State:NH
Practice Address - Zip Code:03447-3149
Practice Address - Country:US
Practice Address - Phone:603-585-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH062618-23363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health