Healthcare Provider Details

I. General information

NPI: 1275522005
Provider Name (Legal Business Name): CARRIE LYNN BROTHERHOOD CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE LYNN SPERKA CST

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC ORTHOPAEDIC SURGERY
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC ORTHOPAEDIC SURGERY
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-337-7300
  • Fax: 414-337-7337
Mailing address:
  • Phone: 414-337-7300
  • Fax: 414-337-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number93552
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: