Provider Demographics
NPI:1750852950
Name:DR RITCHELLE BROADNAX LLC
Entity Type:Organization
Organization Name:DR RITCHELLE BROADNAX LLC
Other - Org Name:BROADNAX HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITCHELLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:BROADNAX
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,CRNP
Authorized Official - Phone:205-540-0083
Mailing Address - Street 1:3066 ZELDA RD # 331
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5303 VAUGHN RD STE 102
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1120
Practice Address - Country:US
Practice Address - Phone:800-221-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty