MEDICARE: MS. SUSAN RENE' BROOKS APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	309701	OH
2	363LA2100X	Acute Care Nurse Practitioner	3017301	KY
3	363LA2100X	Acute Care Nurse Practitioner	109966	WV
4	363LA2100X	Acute Care Nurse Practitioner	APRN.CNP.019309	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H528410	OTHER	OH	MEDICARE PTAN
4	WVD651A	OTHER	WV	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831551688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN RENE' BROOKS APRN-CNP

Provider Business Mailing Address
First Line	:	112 HARCOURT RD STE 2
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3944
Country	:	US
Telephone Number	:	740-326-6069
Fax Number	:	740-326-6069

Provider Business Practice Location Address
First Line	:	112 HARCOURT RD STE 2
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3944
Country	:	US
Telephone Number	:	740-326-6069
Fax Number	:	740-326-6069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	12/10/2024

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