Provider Demographics
NPI:1689711921
Name:BROCK, LINDA JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEAN
Last Name:BROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2624
Mailing Address - Country:US
Mailing Address - Phone:262-567-2856
Mailing Address - Fax:
Practice Address - Street 1:500 RIVERVIEW AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3632
Practice Address - Country:US
Practice Address - Phone:262-970-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53495-030163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health