Provider Demographics
NPI:1891921912
Name:VANROOSENBEEK, BRENDA L
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:VANROOSENBEEK
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 1:36500 AURORA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4899
Mailing Address - Country:US
Mailing Address - Phone:262-434-7300
Mailing Address - Fax:262-434-7351
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066-4899
Practice Address - Country:US
Practice Address - Phone:262-434-7300
Practice Address - Fax:262-434-7351
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI125407-030163W00000X
WI3902-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse