Healthcare Provider Details

I. General information

NPI: 1477482792
Provider Name (Legal Business Name): BROOKE WEIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W BROADWAY AVE
MEDFORD WI
54451-1307
US

IV. Provider business mailing address

W6844 LIBERTY LN
PHILLIPS WI
54555-7657
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-5580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18721-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number254699-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: