Provider Demographics
NPI:1831551688
Name:BROOKS, SUSAN RENE' (APRN-CNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RENE'
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:112 HARCOURT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3944
Mailing Address - Country:US
Mailing Address - Phone:740-326-6069
Mailing Address - Fax:740-326-6069
Practice Address - Street 1:112 HARCOURT RD STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3944
Practice Address - Country:US
Practice Address - Phone:740-326-6069
Practice Address - Fax:740-326-6069
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH309701163WE0003X
KY3017301363LA2100X
WV109966363LA2100X
OHAPRN.CNP.019309363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1831551688Medicaid
OHH528410OtherMEDICARE PTAN
OH0189034Medicaid
WVWVD651AOtherMEDICARE PTAN