Individual
MS. BROOKE MARIE LUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
STUDENT
Contact information
Practice address
1936 PARKNOLL LN, PORT WASHINGTON, WI 53074-1177
(262) 323-2962
Mailing address
1936 PARKNOLL LN, PORT WASHINGTON, WI 53074-1177
(262) 323-2962
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
NONE
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
06/11/2021
Last updated
06/11/2021
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