Mary Ann Broda, C.P.N.P.

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704119440 Issued in MI

Practice address

106 E Main St
Spring Arbor, MI 49283-9701

Phone

(517) 750-6352

Fax

(517) 750-6625

NPI assigned

Sep 26, 2006

Last updated

Feb 16, 2016By the provider in NPPES

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 identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mbroda522049@direct.hfhs.org

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

• Spring Arbor University

  dba Holton Health and Wellness Center

  • Family Medicine Physician
  • Spring Arbor, MI
  • NPI 1821347741
  NPD (past)
• Spring Arbor University Physical Therapy and Athletic Training LLC

  • Physical Therapist
  • Spring Arbor, MI
  • NPI 1649740465
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455580800000",
    "number": "1356442842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E MAIN ST",
            "city": "SPRING ARBOR",
            "state": "MI",
            "postal_code": "492839701",
            "telephone_number": "517-740-9869",
            "fax_number": "517-750-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E MAIN ST",
            "city": "SPRING ARBOR",
            "state": "MI",
            "postal_code": "492839701",
            "telephone_number": "517-750-6352",
            "fax_number": "517-750-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODA",
        "first_name": "MARY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "C.P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2016-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704119440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "83 20029",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "470411940",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Rebekah Asman
• Sara J Bekemeier, O.T.R.
• Jennifer Elizabeth Benedict, MAT, AT, ATC
• Leela Bharathi, P.T.
• David Brock
• Raelynn Burger, LMSW
• Lynne Burlingame, SLP
• Robert Leon Cole, DDS
• Common Sense Counseling
• Cornerstone Caregiving East LLC

• Pediatric Nurse Practitioner in Spring Arbor, MI
• Providers in Spring Arbor, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.