Individual
LATHEA BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6010 W CALUMET RD APT 104, MILWAUKEE, WI 53223-4127
(414) 202-7465
(414) 446-9916
Mailing address
6010 W CALUMET RD APT 104, MILWAUKEE, WI 53223-4127
(414) 202-7465
(414) 446-9916
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
B6205249184602
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464796343
DEPT. OF REVENUE
WI
Enumeration date
01/10/2018
Last updated
06/16/2018
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