1811879125 NPI number — MISS BROOKE MARIE KLATKIEWICZ MS, RDN

Table of content: MISS BROOKE MARIE KLATKIEWICZ MS, RDN (NPI 1811879125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811879125 NPI number — MISS BROOKE MARIE KLATKIEWICZ MS, RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLATKIEWICZ
Provider First Name:
BROOKE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811879125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12037 W EDGERTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALES CORNERS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53130-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-614-9936
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-805-7782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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