Broerman, Nicole Stack
Broerman, Nicole Stack is an sole proprietor health care provider with primary practice located at 462 Elma G Miles Pkwy , Hinesville GA 31313-4000. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Broerman, Nicole Stack can be contacted via phone (912) 369-9400.Contact Information
Primary practice address
462 Elma G Miles Pkwy
Hinesville GA 31313-4000
Phone: (912) 369-9400
Fax: (912) 877-9438
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 47265 | Georgia |
Profile Details
| NPI number | 1013902741 |
|---|---|
| LBN Legal business name | Broerman, Nicole Stack |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 19th, 2005 |
| Last updated | Apr 17th, 2018 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013902741 | NPPES |
| Georgia | MEDICAID | T74835 |
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