Mary Ann Brooks, CNP
Individual provider Active NPI Neonatal Nurse Practitioner · Rapid City, SD
NPI 1962525840 · NPPES record last updated Oct 14, 2011
Key facts
- NPI
- 1962525840
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neonatal Nurse Practitioner 363LN0000X
- License
- CP000097 (SD)
- Practice address
- 353 Fairmont Blvd.
Rapid City, SD 57701 - Phone
- (605) 719-1000
- Fax
- (605) 719-1027
- NPI assigned
- Apr 7, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R014468 | SD | MD | Nurse Practitioner |
| CP000097 | SD | MD | Neonatal Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal Nurse Practitioner | 363LN0000X | CP000097 | SD | Yes |
| Nurse Practitioner | 363L00000X | R014468 | SD |
Addresses
Primary practice location
353 Fairmont Blvd.
Rapid City, SD 57701
Mailing address
353 Fairmont Blvd
Atten Medical Staff Services
Rapid City, SD 57701-6000
Phone (605) 719-7109
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CP000097 | Other | SD | CNP LICENSE |
| 9254066 | Other | SD | DAKOTACARE |
| 4993197 | Other | SD | WELLMARK |
| 6829310 | Medicaid | SD | |
| R014468 | Other | SD | RN LICENSE |
Other names
- Mary Ann Mitzel
Other providers in Rapid City, SD
- Patrick Britton
- Ted Brockett
- Cinthia Brockhoft
- Thomas Brockhoft
- Tyler James Broghammer
- Stephanie Brooks
- Kaitlan Elise Brosnahan
- Laura Broten
- Amber Shelly Rose Brown
- Douglas Thorburn Brown
All providers in Rapid City, SD · Neonatal Nurse Practitioner in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.