Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 10326-33 | WI |
NPI | 1033722392 |
---|---|
Provider Name | Margaret M Brochocki |
First Address | Green Bay, WI 54305-2040 |
Second Address | De Pere, WI 54115-4050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2020044401 | AMERICAN NURSES CREDENTIALING CENTER (01) | WI |