Provider Demographics
NPI:1275679961
Name:BROOKSHIRE, VICTORIA E (CFNP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:E
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2912 SPRINGBORO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:
Practice Address - Street 1:8701 OLD TROY PIKE
Practice Address - Street 2:SUITE 20
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1066
Practice Address - Country:US
Practice Address - Phone:937-233-7146
Practice Address - Fax:937-237-4776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA 06422-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000852321OtherANTHEM
OH2850615Medicaid
OH2850615Medicaid