Carla Marie Broderick
Nurse Practitioner - Adult Health
2215 Portland Ave
Louisville
, Kentucky 40212
Carla Marie Broderick
Nurse Practitioner - Adult Health
2215 Portland Ave
Louisville
, Kentucky 40212
(502) 776-8912
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About
Features
Specialties
- Nurse Practitioner - Adult Health
Languages spoken
- English
Location
First Address
- Carla Marie Broderick
- Po Box 950244
- Louisville, KY
- Zip : 40295-0244
- Fax : (502) 776-8912
- Phone : (502) 953-4700
Second Address
- Carla Marie Broderick
- 2215 Portland Ave
- Louisville, KY
- Zip : 40212
- Fax : (502) 996-8309
- Phone : (502) 774-8631
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LA2200X | Nurse Practitioner - Adult Health | 3002744 | KY |
National Provider Identifier
| NPI | 1033115878 |
|---|---|
| Provider Name | Carla Marie Broderick |
| First Address | Louisville, KY 40295-0244 |
| Second Address | Louisville, KY 40212 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/06/2005 |
| Last Update Date | 13/04/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000200893 | ANTHEM (01) | KY |
| 78009859 | (05) | KY |
| S70310 | (02) | KY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.