Provider Demographics
NPI:1124257365
Name:BROOKS, DENISE MELISSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MELISSA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MELISSA
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:7650 E PARHAM RD STE 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4376
Practice Address - Country:US
Practice Address - Phone:804-916-7062
Practice Address - Fax:804-918-2172
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant