Provider Demographics
NPI:1770082976
Name:O'CONNOR, BROOKE NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:603-308-1472
Mailing Address - Fax:
Practice Address - Street 1:454 OLD STREET ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458
Practice Address - Country:US
Practice Address - Phone:603-924-4646
Practice Address - Fax:877-673-1404
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2315776163WC1500X
NH076457-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health