Active NPI
Mary Kay Brodrick, RN
- Case Management Registered Nurse
- Novi, MI
National Provider Identifier
1114691797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Registered Nurse
- License
- 4704238653
- Practice address
- 48190 W 10 Mile Rd
Novi, MI 48374-2813 - Phone
- (313) 590-5835
- Fax
- (708) 910-3138
- NPI assigned
- Aug 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 4704238653 | MI | Primary |
Addresses
Primary practice location
48190 W 10 Mile Rd
Novi, MI 48374-2813
Mailing address
48190 W 10 Mile Rd
Novi, MI 48374-2813
Phone (313) 590-5835
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704238653 | Other | MI | NURSING LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704238653 | MI | MD | Case Management Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628121600000",
"number": "1114691797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48190 W 10 MILE RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483742813",
"telephone_number": "313-590-5835",
"fax_number": "708-910-3138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48190 W 10 MILE RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483742813",
"telephone_number": "313-590-5835",
"fax_number": "708-910-3138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODRICK",
"first_name": "MARY",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-05",
"last_updated": "2021-08-05",
"certification_date": "2021-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Case Management",
"state": "MI",
"license": "4704238653",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSING LICENSE",
"identifier": "4704238653",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.