MEDICARE: DR. TERRI L BROOKSHIRE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1336875665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRI L BROOKSHIRE

Provider Business Mailing Address
First Line	:	10518 W FOUNTAIN AVE APT 811
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3235
Country	:	US
Telephone Number	:	414-688-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	10518 W FOUNTAIN AVE APT 811
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3235
Country	:	US
Telephone Number	:	414-688-0410
Fax Number	:

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

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	07/28/2022

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