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Individual

CARLA MARIE BRODERICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212
(502) 774-8631
(502) 996-8309
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 953-4700
(502) 776-8912

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3002744
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000200893
ANTHEM
KY
05
78009859
KY
Enumeration date
06/27/2005
Last updated
01/25/2023
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