Healthcare Provider Details

I. General information

NPI: 1932768959
Provider Name (Legal Business Name): BROOKE E JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HOSPITAL RD
NEW RICHMOND WI
54017-1449
US

IV. Provider business mailing address

1801 HICKMAN RD
DES MOINES IA
50314-1505
US

V. Phone/Fax

Practice location:
  • Phone: 715-243-3400
  • Fax:
Mailing address:
  • Phone: 515-282-5640
  • Fax: 515-282-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82009
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-11543
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: