Provider Demographics
NPI:1336875665
Name:BROOKSHIRE, TERRI L
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
Last Name:BROOKSHIRE
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 1:10518 W FOUNTAIN AVE APT 811
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3235
Mailing Address - Country:US
Mailing Address - Phone:414-688-0410
Mailing Address - Fax:
Practice Address - Street 1:10518 W FOUNTAIN AVE APT 811
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3235
Practice Address - Country:US
Practice Address - Phone:414-688-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator