Provider Demographics
NPI:1881337004
Name:BRODIE, ASIA M (LPN)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:M
Last Name:BRODIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E SIDNEY AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1472
Mailing Address - Country:US
Mailing Address - Phone:914-320-3239
Mailing Address - Fax:
Practice Address - Street 1:40 E SIDNEY AVE APT 2L
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1472
Practice Address - Country:US
Practice Address - Phone:914-320-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338984164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse