Healthcare Provider Details

I. General information

NPI: 1194492637
Provider Name (Legal Business Name): BROOKE ELIZABETH VAN ZEELAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ELIZABETH ERICSON

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 SHAWANO AVE
GREEN BAY WI
54303-3216
US

IV. Provider business mailing address

1726 SHAWANO AVE
GREEN BAY WI
54303-3216
US

V. Phone/Fax

Practice location:
  • Phone: 920-884-3135
  • Fax:
Mailing address:
  • Phone: 920-884-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11384-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11384-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number200885-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: