Provider Demographics
NPI:1235566365
Name:BROADWELL, EMILEE B (RN, LMT)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:B
Last Name:BROADWELL
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 LODI CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HECTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14841-9732
Mailing Address - Country:US
Mailing Address - Phone:607-869-9636
Mailing Address - Fax:
Practice Address - Street 1:7263 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521
Practice Address - Country:US
Practice Address - Phone:607-869-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22645928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse