Healthcare Provider Details

I. General information

NPI: 1457228108
Provider Name (Legal Business Name): BROOKE HAILEY PEACOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GENERAL ST
LAWRENCE MA
01841-2961
US

IV. Provider business mailing address

1435 AMES HILL DR
TEWKSBURY MA
01876-1180
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number08526821
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2334095
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: