Provider Demographics
NPI:1518354927
Name:BRODERICK, ANJULIE
Entity Type:Individual
Prefix:
First Name:ANJULIE
Middle Name:
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:1760 E PECOS RD
Practice Address - Street 2:STE 516
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3200
Practice Address - Country:US
Practice Address - Phone:480-814-1910
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife