Healthcare Provider Details

I. General information

NPI: 1245134402
Provider Name (Legal Business Name): BROOKLYN ANN BARRETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 9TH ST
DE PERE WI
54115-1393
US

IV. Provider business mailing address

3341 ANSTON RD
SUAMICO WI
54313-8227
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-5680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberWI040400201820
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: