Provider Demographics
NPI:1033500046
Name:BROADNAX, RITCHELLE (DNP,CRNP)
Entity Type:Individual
Prefix:
First Name:RITCHELLE
Middle Name:
Last Name:BROADNAX
Suffix:
Gender:F
Credentials:DNP,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 ZELDA RD # 331
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2651
Mailing Address - Country:US
Mailing Address - Phone:334-467-5973
Mailing Address - Fax:
Practice Address - Street 1:5301 VAUGHN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:205-540-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591806363LF0000X
AL1-094939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily