Provider Demographics
NPI:1770216079
Name:POLZER, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:POLZER
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:N6454 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:ARKANSAW
Mailing Address - State:WI
Mailing Address - Zip Code:54721-9206
Mailing Address - Country:US
Mailing Address - Phone:715-279-3546
Mailing Address - Fax:
Practice Address - Street 1:N6454 JOYCE RD
Practice Address - Street 2:
Practice Address - City:ARKANSAW
Practice Address - State:WI
Practice Address - Zip Code:54721-9206
Practice Address - Country:US
Practice Address - Phone:715-279-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program