Healthcare Provider Details

I. General information

NPI: 1770082976
Provider Name (Legal Business Name): BROOKE NICOLE O'CONNOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2018
Last Update Date: 01/06/2025
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 OLD STREET ROAD SUITE 201
PETERBOROUGH NH
03458
US

IV. Provider business mailing address

PO BOX 810
HANOVER NH
03755-0810
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-4646
  • Fax: 877-673-1404
Mailing address:
  • Phone: 603-308-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number076457-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2315776
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: