Individual
TINA C BROSSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
N16012 CTY RD T, WITHEE, WI 54498-8353
(872) 231-3162
Mailing address
PO BOX 74008272, CHICAGO, IL 60674-8272
(872) 231-3162
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
8487-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088479
—
WI
Enumeration date
07/23/2018
Last updated
05/07/2026
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