Provider Demographics
NPI:1245084573
Name:BROADERS, ERICA MARIE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:BROADERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 SANSA ST
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8753
Mailing Address - Country:US
Mailing Address - Phone:219-999-4447
Mailing Address - Fax:
Practice Address - Street 1:8337 SANSA ST
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8753
Practice Address - Country:US
Practice Address - Phone:219-999-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-016903-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care