Individual
ANTHONY R BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5185
(208) 625-6892
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5085
(208) 625-5731
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP675A
ID
363L00000X
Nurse Practitioner
Primary
RN33608
ID
Other
Enumeration date
09/13/2006
Last updated
08/28/2019
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