MEDICARE: QUINESHA BROOKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider		WI
2	376K00000X	Nurse's Aide	360924	WI

General Provider Information

NPI Number	:	1184330391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINESHA BROOKS

Provider Business Mailing Address
First Line	:	1655 N MAYFAIR RD PO BOX 13003
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213
Country	:	US
Telephone Number	:	720-446-8395
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W LAGOON LN APT 1808
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-2995
Country	:	US
Telephone Number	:	720-446-8395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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Directions to “ QUINESHA BROOKS ” Practice Location

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