Organization
NICOLE BRODERSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS NICOLE R BRODERSON CNP (NURSE PRACTITIONER)
(505) 428-0072
Entity
Organization
Contact information
Practice address
1421 LUISA ST, SUITE N, SANTA FE, NM 87505-4073
(505) 428-0072
(888) 256-1158
Mailing address
1421 LUISA ST, SUITE N, SANTA FE, NM 87505-4073
(505) 428-0072
(888) 256-1158
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MB2485490
NM
Other
Enumeration date
02/27/2012
Last updated
07/31/2013
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