Provider Demographics
NPI:1275748295
Name:BRODNANSKY, NEYDA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NEYDA
Middle Name:
Last Name:BRODNANSKY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 W 6TH ST
Mailing Address - Street 2:#120
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-428-4699
Mailing Address - Fax:
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:#120
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-428-4699
Practice Address - Fax:310-833-2462
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily