Provider Demographics
NPI:1205448958
Name:BROADWAY-SPINNER, JULIE KATHERINE (PMHNP, RN-BC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KATHERINE
Last Name:BROADWAY-SPINNER
Suffix:
Gender:F
Credentials:PMHNP, RN-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BROADWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP, RN-BC
Mailing Address - Street 1:916 PACIFIC ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3190
Mailing Address - Country:US
Mailing Address - Phone:347-420-9191
Mailing Address - Fax:
Practice Address - Street 1:916 PACIFIC ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3190
Practice Address - Country:US
Practice Address - Phone:347-420-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674182363LP0808X
NY403214363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health