Provider Demographics
NPI:1306185400
Name:BROADWELL, WHITNEY JOHNSON (RN)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JOHNSON
Last Name:BROADWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15269 INDIAN MOUND RD
Mailing Address - Street 2:
Mailing Address - City:WARE SHOALS
Mailing Address - State:SC
Mailing Address - Zip Code:29692-3547
Mailing Address - Country:US
Mailing Address - Phone:864-456-7496
Mailing Address - Fax:864-861-4338
Practice Address - Street 1:15269 INDIAN MOUND RD
Practice Address - Street 2:
Practice Address - City:WARE SHOALS
Practice Address - State:SC
Practice Address - Zip Code:29692-3547
Practice Address - Country:US
Practice Address - Phone:864-456-7496
Practice Address - Fax:864-861-4338
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC203589163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool