Healthcare Provider Details

I. General information

NPI: 1548478662
Provider Name (Legal Business Name): NICOLE L HEMBROOK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE L BROIHAHN BA

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 GANSER WAY SUITE 204
MADISON WI
53719-2092
US

IV. Provider business mailing address

2225 HILLDALE CIR
STOUGHTON WI
53589-4678
US

V. Phone/Fax

Practice location:
  • Phone: 608-829-1800
  • Fax: 608-829-1885
Mailing address:
  • Phone: 608-220-3929
  • Fax: 608-829-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: