Provider Demographics
NPI:1841658671
Name:BRODERICK, JOYCE (RN)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:BRODERICK
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 1:388 BELCODA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14546-9721
Mailing Address - Country:US
Mailing Address - Phone:585-967-9554
Mailing Address - Fax:
Practice Address - Street 1:388 BELCODA RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14546-9721
Practice Address - Country:US
Practice Address - Phone:585-967-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654149163W00000X
FLRN9426217163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse