Provider Demographics
NPI:1780952127
Name:MCGUIRE, BROOKE NICOLE (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:MCGUIRE
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:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:15101 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:KS
Practice Address - Zip Code:66223-3154
Practice Address - Country:US
Practice Address - Phone:913-681-8866
Practice Address - Fax:913-681-6134
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS144080163W00000X
KS53-75572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse