Provider Demographics
NPI:1407164635
Name:BROUDER, LORETTA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:BROUDER
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 1:433 E 237TH ST
Mailing Address - Street 2:BRONX
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2002
Mailing Address - Country:US
Mailing Address - Phone:347-873-0342
Mailing Address - Fax:
Practice Address - Street 1:433 E 237TH ST
Practice Address - Street 2:BRONX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2002
Practice Address - Country:US
Practice Address - Phone:347-873-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265613-1163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency