Healthcare Provider Details

I. General information

NPI: 1568395580
Provider Name (Legal Business Name): BROOKE MARIE HARTWIG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 MADISON AVE
FORT ATKINSON WI
53538-3100
US

IV. Provider business mailing address

308 JACKSON ST
FORT ATKINSON WI
53538-1632
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-7888
  • Fax:
Mailing address:
  • Phone: 920-728-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: