Individual
JEROME BROAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
555 N DUKE ST, LANCASTER, PA 17602-2250
(717) 544-5511
Mailing address
555 N DUKE ST, LANCASTER, PA 17602-2250
(717) 544-5511
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN326693L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000535767
HIGHMARK
PA
01
—
0229988000
INDEPENDENCE BLUE CROSS
PA
01
—
106579
GEISINGER
PA
01
—
1147543
AETNA-HMO
PA
01
—
4574637
AETNA-NON HMO
PA
01
—
50055744
CAPITAL BLUE CROSS
PA
01
—
P00233842
RR MEDICARE
PA
Enumeration date
03/20/2006
Last updated
03/30/2011
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