Provider Demographics
NPI:1811653249
Name:BROSCIOUS, BRIANNA M (LPN)
Entity type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:M
Last Name:BROSCIOUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:MARIE
Other - Last Name:BROSCIOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:BRIANNA M BROSCIOUS
Mailing Address - Street 2:152 CLARA ROAD
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748
Mailing Address - Country:US
Mailing Address - Phone:585-307-9665
Mailing Address - Fax:
Practice Address - Street 1:BRIANNA M BROSCIOUS
Practice Address - Street 2:152 CLARA ROAD
Practice Address - City:SHINGLEHOUSE
Practice Address - State:PA
Practice Address - Zip Code:16748
Practice Address - Country:US
Practice Address - Phone:585-307-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse