Nicole Denice Broderson, MS, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

221 Michigan St NE Ste 200
Grand Rapids, MI 49503-2533

Phone

(616) 267-8950

NPI assigned

Nov 15, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1073388559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MICHIGAN ST NE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032533",
            "telephone_number": "616-267-8950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERSON",
        "first_name": "NICOLE",
        "middle_name": "DENICE",
        "credential": "MS, RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-15",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaelee Sara Brockway, PT, DPT, GCS, CEEAA
• Danielle K Brodberg, AT, ATC
• Cassandra Broden
• Jerome Daniel Broderick, P.T.
• Jacqueline Broders, PT, DPT
• Beth Ann Brodnicki, MSPT, CMLDT
• Steven Eric Brodnicki, P.T.
• Mary B Broeckert, MD
• Amy Broekstra, RDH
• Erin E Broene, NP

• Registered Dietitian in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.