Provider Demographics
NPI:1528746773
Name:JESKE, BROOKE LAINE (APNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LAINE
Last Name:JESKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LAINE
Other - Last Name:NAVULIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2493 BALL DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53076-9520
Mailing Address - Country:US
Mailing Address - Phone:920-767-1406
Mailing Address - Fax:
Practice Address - Street 1:912 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5530
Practice Address - Country:US
Practice Address - Phone:920-907-3922
Practice Address - Fax:920-929-7392
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13662-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily