Provider Demographics
NPI:1477370260
Name:BROADY, MARLENE (RN)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:BROADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 PIEDMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9458
Mailing Address - Country:US
Mailing Address - Phone:336-289-8648
Mailing Address - Fax:
Practice Address - Street 1:4050 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9458
Practice Address - Country:US
Practice Address - Phone:336-289-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK122181163W00000X
CA635783163W00000X
CT153241163W00000X
HIRN86569163W00000X
IL041.336514163W00000X
MARN2341836163W00000X
MI4704334397163W00000X
MN2457159163W00000X
NVRN41484163W00000X
NY556561163W00000X
OR201707838RN163W00000X
PARN544167163W00000X
TX695105163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse