Provider Demographics
NPI:1598119422
Name:WEHAUSEN, BROOKE (DO)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WEHAUSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4210
Mailing Address - Country:US
Mailing Address - Phone:804-264-4545
Mailing Address - Fax:804-264-4260
Practice Address - Street 1:7813 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4210
Practice Address - Country:US
Practice Address - Phone:804-264-4545
Practice Address - Fax:804-264-4260
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102205993207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty