Provider Demographics
NPI:1538490032
Name:BROUDER, CORINA MARY ANN (LPN, BA)
Entity Type:Individual
Prefix:MISS
First Name:CORINA
Middle Name:MARY ANN
Last Name:BROUDER
Suffix:
Gender:F
Credentials:LPN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 EAST 237TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470
Mailing Address - Country:US
Mailing Address - Phone:347-249-4832
Mailing Address - Fax:
Practice Address - Street 1:98 E 237TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1906
Practice Address - Country:US
Practice Address - Phone:347-249-4832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254629-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse