Brooke, Bradley R

Brooke, Bradley R is an individual health care provider with primary practice located at 3200 Pleasant Valley Rd , West Bend WI 53095-9274. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Brooke, Bradley R can be contacted via phone (262) 334-5533.

Contact Information

Primary practice address
3200 Pleasant Valley Rd West Bend WI 53095-9274
Phone: (262) 334-5533
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 152184-30 Wisconsin

Profile Details

NPI number 1558377333
LBN Legal business name Brooke, Bradley R
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558377333 NPPES
Wisconsin MEDICAID 44350800

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