Provider Demographics
NPI:1851473193
Name:BROADARD, RAUSHANAH L (PA-C)
Entity Type:Individual
Prefix:
First Name:RAUSHANAH
Middle Name:L
Last Name:BROADARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N SHIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-2228
Mailing Address - Country:US
Mailing Address - Phone:302-655-7293
Mailing Address - Fax:302-254-4470
Practice Address - Street 1:625 N SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2228
Practice Address - Country:US
Practice Address - Phone:302-655-7293
Practice Address - Fax:302-254-4470
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant