Broderick, Carla Marie

Broderick, Carla Marie is an individual health care provider with primary practice located at 2215 Portland Ave , Louisville KY 40212. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Broderick, Carla Marie can be contacted via phone (502) 774-8631.

Contact Information

Primary practice address
2215 Portland Ave Louisville KY 40212
Phone: (502) 774-8631
Fax: (502) 996-8309
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 3002744 Kentucky

Profile Details

NPI number 1033115878
LBN Legal business name Broderick, Carla Marie
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2005
Last updated Jan 25th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033115878 NPPES
Kentucky Other 000000200893 ANTHEM
Kentucky MEDICAID 78009859 ANTHEM

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