Pine River Health Care, Inc.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

174732 Issued in CO

Legal business name

PINE RIVER HEALTH CARE, INC.

Practice address

480 Wolverine Dr
#2B
Bayfield, CO 81122-9653

Phone

(970) 884-5173

Fax

(970) 884-0123

NPI assigned

Oct 8, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nancy Brooker, CNP

Title

Owner, Nurse Practitioner

Phone

(970) 884-5173

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254960000000",
    "number": "1780919712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 WOLVERINE DR",
            "address_2": "#2B",
            "city": "BAYFIELD",
            "state": "CO",
            "postal_code": "811229653",
            "telephone_number": "970-884-5173",
            "fax_number": "970-884-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 WOLVERINE DR",
            "address_2": "#2B",
            "city": "BAYFIELD",
            "state": "CO",
            "postal_code": "811229653",
            "telephone_number": "970-884-5173",
            "fax_number": "970-884-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2009-10-08",
        "status": "A",
        "authorized_official_last_name": "BROOKER",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "OWNER, NURSE PRACTITIONER",
        "authorized_official_telephone_number": "970-884-5173",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "174732",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "174732",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": "174732",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CO",
            "license": "174732",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1982704441",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Grigsby Nicholson, DDS
• Mary E O'Donnell, RPH
• Painted Sky Dental
• Pediatric Partners of the Southwest P.C.
• Pine River Chiropractic Inc
• Pine River Physical Therapy, LLC
• Austin Laura Presas
• Carly Pecoriello Prudic, FNP-BC
• Robert Quinlan, RMT
• Kathleen Quinton

• Nurse Practitioner in Bayfield, CO
• Providers in Bayfield, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.