Provider Demographics
NPI:1962977520
Name:BROOKS, JILLIAN (NP-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:STARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-0505
Mailing Address - Fax:414-955-0231
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0505
Practice Address - Fax:414-955-0231
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962977520Medicaid