Individual
MRS. JANET L. BROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN-BC
Contact information
Practice address
1275 HAWTHORN RD, SALEM, IL 62881-1028
(618) 548-4545
(618) 548-4577
Mailing address
1275 HAWTHORN RD, SALEM, IL 62881-1028
(618) 548-4545
(618) 548-4577
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209.00 8351
IL
363LF0000X
Family Nurse Practitioner
Primary
209.00 8351
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427355003
—
MO
Enumeration date
08/02/2006
Last updated
04/08/2021
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