Provider Demographics
NPI:1235120973
Name:BROSKIE, NANCY ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELAINE
Last Name:BROSKIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GLEN CREEK RD NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3161
Mailing Address - Country:US
Mailing Address - Phone:503-364-7049
Mailing Address - Fax:
Practice Address - Street 1:525 GLEN CREEK RD NW
Practice Address - Street 2:SUITE 240
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3161
Practice Address - Country:US
Practice Address - Phone:503-364-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR179672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR075098Medicaid
ORG11810Medicare UPIN
OR075098Medicaid