Individual
TIRA BRUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-5700
Mailing address
101 S TOWER LN, SAUKVILLE, WI 53080-2502
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/02/2026
Last updated
04/02/2026
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