Provider Demographics
NPI:1679245807
Name:OMNIA WOMEN'S HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:OMNIA WOMEN'S HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:928-287-7158
Mailing Address - Street 1:1170 N ESTRELLA PKWY STE A107
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9276
Mailing Address - Country:US
Mailing Address - Phone:623-263-0105
Mailing Address - Fax:
Practice Address - Street 1:1170 N ESTRELLA PKWY STE A107
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9276
Practice Address - Country:US
Practice Address - Phone:623-263-0105
Practice Address - Fax:623-263-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty