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General NPI Number Information
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NPI Number | 1245713148
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Entity Type | Individual
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Provider Name | BROOKE WITHERS
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Gender | Female
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-5095
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Country | US
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Telephone | 253-966-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 9880 JACKSON ST SE
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City | YELM
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State | WA
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Zip | 98597-7754
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Country | US
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Telephone | 229-854-3105
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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