Traci L Broidrick, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP011049 Issued in PA

Practice address

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

Phone

(610) 402-8111

Fax

(610) 402-1698

NPI assigned

Dec 21, 2010

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

Other names 1

• Traci L Wagner Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twagner11939@direct2.lvhn.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lehigh Valley Physician Group

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  • Allentown, PA
  • NPI 1780155689
  Medicare reassignment
• Lehigh Valley Physician Group

  • Family Medicine Physician
  • East Stroudsburg, PA
  • NPI 1245093368
  NPD
• Lehigh Valley Physician Group

  • Transplant Surgery Physician
  • Allentown, PA
  • NPI 1457309650
  NPD
• Lehigh Valley Physician Group

  • Nephrology Physician
  • Allentown, PA
  • NPI 1730476557
  NPD
• Pulmonary Associates PC

  • Pulmonary Disease Physician
  • Allentown, PA
  • NPI 1245209022
  NPD (past)

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463616000000",
    "number": "1154624732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 783311",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191783311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CEDAR CREST BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036202",
            "telephone_number": "610-402-8111",
            "fax_number": "610-402-1698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROIDRICK",
        "first_name": "TRACI",
        "middle_name": "L",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-21",
        "last_updated": "2016-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP011049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "WAGNER",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jon E Brndjar, D.O.
• Mark Broadwin, MD
• Allison L Brobst, PAC
• Jeffrey T. Brodsky, MD
• Jaime E Broesicke, CRNP
• Joan Bromley
• Rachel Bromley, CRNP
• Diane Louise Brong, LCSW
• Bobbi M Brooks, M.D.
• Charles Michael Brooks, MD

• Family Nurse Practitioner in Allentown, PA
• Providers in Allentown, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.