Provider Demographics
NPI:1851304216
Name:BRODRICK, NICOLE (DNP, C-NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BRODRICK
Suffix:
Gender:F
Credentials:DNP, C-NP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ROZEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP PMHNP
Mailing Address - Street 1:1770 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1770 ELM ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1812
Practice Address - Country:US
Practice Address - Phone:303-273-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0103107-NP363LP0808X
CORXN 0100862-CNS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP83643Medicare UPIN
MN890000310Medicare ID - Type Unspecified