Provider Demographics
NPI:1295821049
Name:BROADBENT, HILARY A (DOM)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:A
Last Name:BROADBENT
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 COMANCHE RD NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3602
Mailing Address - Country:US
Mailing Address - Phone:505-296-3918
Mailing Address - Fax:
Practice Address - Street 1:10301 COMANCHE RD NE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3602
Practice Address - Country:US
Practice Address - Phone:505-296-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM819171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist