Individual
BROOKE ELAINE WILCZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-6482
(859) 323-5956
(859) 323-1080
Mailing address
1077 DUVAL ST APT 103, LEXINGTON, KY 40515-6482
(703) 314-1780
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3018265
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
DO NOT HAVE SUCH NUMBERS
AL
Enumeration date
02/04/2022
Last updated
08/30/2022
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