Provider Demographics
NPI:1063652154
Name:WISEMAN, BROOKE E
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14395
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66285-4395
Mailing Address - Country:US
Mailing Address - Phone:913-341-9316
Mailing Address - Fax:785-865-5695
Practice Address - Street 1:2113 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3149
Practice Address - Country:US
Practice Address - Phone:785-865-5520
Practice Address - Fax:785-865-5695
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator