Individual
BROOKE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
(360) 356-7759
Mailing address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60512558
WA
Other
Enumeration date
05/19/2025
Last updated
05/19/2025
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