Provider Demographics
NPI:1932898897
Name:BRODIN, EMILY DIANE (RN, APRN-NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DIANE
Last Name:BRODIN
Suffix:
Gender:F
Credentials:RN, APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 N SPRINGBROOK RD STE B
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2061
Mailing Address - Country:US
Mailing Address - Phone:503-449-8988
Mailing Address - Fax:503-894-9194
Practice Address - Street 1:1014 N SPRINGBROOK RD STE B
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2061
Practice Address - Country:US
Practice Address - Phone:503-449-8988
Practice Address - Fax:503-894-9194
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10008015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily