Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1001168 | WI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 150661 | NC |
N | 204E00000X | Oral & Maxillofacial Surgeon | 64325 | WI |
NPI | 1508028820 |
---|---|
Provider Name | Dr. Carolyn C Brookes |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 10/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1508028820 | (05) | WI |