Stephanie Lauren Broderick, CNM, WHNP-BC

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

209013055 Issued in IL

Practice address

1400 Indian Ave
Aurora, IL 60505-3137

Phone

(630) 892-4355

NPI assigned

Aug 11, 2015

Last updated

May 10, 2022By 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 names 1

• Stephanie Lauren Waggoner Former name

Medicare fee-for-service enrollment

Enrolled in IL

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

Certified Nurse Midwife, Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: sbroderick586550@direct.ochin.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.

• Vna Health Care

  • General Practice Physician
  • Aurora, IL
  • NPI 1508826983
  NPD (past)

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1629444823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N HIGHLAND AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605063814",
            "telephone_number": "630-892-4355",
            "fax_number": "630-892-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 INDIAN AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605053137",
            "telephone_number": "630-892-4355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Highland Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605063814",
            "country_code": "US",
            "telephone_number": "630-892-4355",
            "fax_number": "630-892-0262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "STEPHANIE",
        "middle_name": "LAUREN",
        "credential": "CNM, WHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IL",
            "license": "209013055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "WAGGONER",
            "middle_name": "LAUREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Obstetrics & Gynecology Nurse Practitioner in Aurora, IL
• Providers in Aurora, IL by specialty
• Obstetrics & Gynecology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.