Provider Demographics
NPI:1558442848
Name:BRODEUR, HELENE F (NP)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:F
Last Name:BRODEUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2334
Mailing Address - Country:US
Mailing Address - Phone:585-235-0360
Mailing Address - Fax:585-235-1617
Practice Address - Street 1:819 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2334
Practice Address - Country:US
Practice Address - Phone:585-235-0360
Practice Address - Fax:585-235-1617
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382407363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03838539Medicaid
NY03838539Medicaid
NYJ400281217-GRP70008AMedicare PIN