Individual
IDA ELISE BROADWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE STREET, 6 SILVERSTEIN, PHILADELPHIA, PA 19104
(215) 615-4949
Mailing address
3400 SPRUCE STREET, 6 SILVERSTEIN, PHILADELPHIA, PA 19104
(215) 615-4949
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP013545
PA
Other
Enumeration date
11/14/2013
Last updated
12/20/2013
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