Individual
NICOLE BRODERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MSN, PMHNP-BC
Contact information
Practice address
1421 LUISA ST, SUITE N, SANTA FE, NM 87505-4073
(505) 428-0072
(888) 256-1158
Mailing address
PO BOX 23901, SANTA FE, NM 87502-3901
(505) 428-0072
(888) 256-1158
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP-01815
NM
Other
Enumeration date
08/27/2011
Last updated
07/31/2013
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