Individual
REBECCA BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNPC-AG, BSN, RN
Contact information
Practice address
677 WOODLAND SQUARE LOOP SE STE D7, LACEY, WA 98503-1000
(703) 447-6155
Mailing address
18824 MOUNTAIN POINT DR, EAGLE RIVER, AK 99577-8555
(703) 447-6155
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
61413663-NP
WA
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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