Provider Demographics
NPI:1679299333
Name:BROOKS, GLORIA II (124411-30RN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BROOKS
Suffix:II
Gender:F
Credentials:124411-30RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W241N2559EAST PARKWAY MEADOW C
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072
Mailing Address - Country:US
Mailing Address - Phone:262-225-8944
Mailing Address - Fax:
Practice Address - Street 1:W241N2559EAST PARKWAY MEADOW C
Practice Address - Street 2:UNIT 2
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072
Practice Address - Country:US
Practice Address - Phone:262-225-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124411-30163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty