Provider Demographics
NPI:1265789028
Name:WIEBE, BROOKE (RN BSN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WIEBE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 N OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4031
Mailing Address - Country:US
Mailing Address - Phone:316-425-7088
Mailing Address - Fax:
Practice Address - Street 1:137 N OLIVER AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4031
Practice Address - Country:US
Practice Address - Phone:316-425-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-101661-012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse