MEDICARE: MS. VICTORIA E BROOKSHIRE CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA 06422-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000852321	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275679961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA E BROOKSHIRE CFNP

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO RD
Second Line	:	SUITE 201
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 OLD TROY PIKE
Second Line	:	SUITE 20
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1066
Country	:	US
Telephone Number	:	937-233-7146
Fax Number	:	937-237-4776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/07/2015

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