Individual
MRS. STACY SHELTON BROADDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP, CNM
Contact information
Practice address
4801 ALBERTA AVE, EL PASO, TX 79905-2707
(915) 545-6490
(915) 783-6228
Mailing address
4801 ALBERTA AVE, EL PASO, TX 79905-2707
(915) 545-6490
(915) 783-6228
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
5301741
TX
Other
Enumeration date
07/25/2011
Last updated
07/25/2011
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