Provider Demographics
NPI:1588281125
Name:BROOKS, MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LIBBEY PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3130
Mailing Address - Country:US
Mailing Address - Phone:781-682-0649
Mailing Address - Fax:
Practice Address - Street 1:90 LIBBEY PKWY STE 106
Practice Address - Street 2:
Practice Address - City:EAST WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3130
Practice Address - Country:US
Practice Address - Phone:781-682-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287135163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse