Provider Demographics
NPI:1467433243
Name:BRODRICK, ELLEN M (CNM)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:BRODRICK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-436-4949
Mailing Address - Fax:303-602-8277
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:303-602-8277
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2179363L00000X
MN32367A00000X
MNR 207187-5367A00000X
WI138047367A00000X
COAPN.0994633-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74679Medicare UPIN
MN420001197Medicare PIN