Healthcare Provider Details

I. General information

NPI: 1831551688
Provider Name (Legal Business Name): SUSAN RENE' BROOKS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN BROOKS AGACNP-BC

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HARCOURT RD STE 2
MOUNT VERNON OH
43050-3944
US

IV. Provider business mailing address

112 HARCOURT RD STE 2
MOUNT VERNON OH
43050-3944
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-6069
  • Fax: 740-326-6069
Mailing address:
  • Phone: 740-326-6069
  • Fax: 740-326-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3017301
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number109966
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.019309
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number309701
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: