Provider Demographics
NPI:1023021714
Name:BROOKE, WENDY (RD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BROOKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1892 WILLIAMS STREET
Mailing Address - Street 2:
Mailing Address - City:FORT HARRISON
Mailing Address - State:MT
Mailing Address - Zip Code:59636
Mailing Address - Country:US
Mailing Address - Phone:406-447-7365
Mailing Address - Fax:
Practice Address - Street 1:1892 WILLIAMS STREET
Practice Address - Street 2:NUTRITION AND FOOD SERVICE
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered