Provider Demographics
NPI:1649577586
Name:BROOM, NATASHA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:JEAN
Last Name:BROOM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:JEAN
Other - Last Name:WERNIMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4342
Mailing Address - Country:US
Mailing Address - Phone:712-264-6198
Mailing Address - Fax:
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:712-264-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD125145367500000X
IA125145390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered