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General NPI Number Information
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NPI Number | 1023021714
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Entity Type | Individual
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Provider Name | WENDY BROOKE R.D.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 1892 WILLIAMS STREET NUTRITION AND FOOD SERVICE
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City | FORT HARRISON
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State | MT
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Zip | 59636
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Country | US
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Telephone | 406-447-7365
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Fax |
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Provider Business Mailing Address
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Address Line | 1892 WILLIAMS STREET
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City | FORT HARRISON
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State | MT
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Zip | 59636
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Country | US
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Telephone | 406-447-7365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 340
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License Number State | MT
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