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Individual

MARY ANN BROOKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
353 FAIRMONT BLVD., RAPID CITY, SD 57701
(605) 719-1000
(605) 719-1027
Mailing address
353 FAIRMONT BLVD, ATTEN MEDICAL STAFF SERVICES, RAPID CITY, SD 57701-6000
(605) 719-7109
(605) 719-1027

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R014468
SD
363LN0000X
Neonatal Nurse Practitioner
Primary
CP000097
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4993197
WELLMARK
SD
05
6829310
SD
01
9254066
DAKOTACARE
SD
01
CP000097
CNP LICENSE
SD
01
R014468
RN LICENSE
SD
Enumeration date
04/07/2007
Last updated
10/14/2011
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