Broda L Miller, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043089365 Issued in IL

Practice address

639 York St RM 212
Quincy, IL 62301-3919

Phone

(217) 222-6277

NPI assigned

Oct 31, 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

Other names 1

• Broda L Holloway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1649043753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 OLD SOUTH RIVER RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633034120",
            "telephone_number": "636-224-1210",
            "fax_number": "636-246-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 YORK ST RM 212",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013919",
            "telephone_number": "217-222-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BRODA",
        "middle_name": "L",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-31",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043089365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRODA",
            "last_name": "HOLLOWAY",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Midwest Orthopedic Specialists Inc
• Midwest Orthopedic Specialists Inc
• Andrew Philip Milian, MD
• Erica Marie Miller-Spears, PA-C
• Ashley Marie Miller, APRN
• Coletta M Miller, D.D.S.
• Courtney Lynn Miller, M.S.ED, LCPC
• Danielle Elizabeth Miller, APRN-AGACNP
• Gina Brunetti Miller, MS, LCSW
• Mary Carroll Miller, MD

• Licensed Practical Nurse in Quincy, IL
• Providers in Quincy, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.