Nichole Broekhuis, RN, BSN, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APRN.CNP0036317 Issued in OH

Practice address

721 Miami Chapel Rd
Dayton, OH 45417-4650

Phone

(937) 281-6800

NPI assigned

Apr 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Bachelor on Science - Nursing, Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Five Rivers Health Centers

  • Family Medicine Physician
  • Dayton, OH
  • NPI 1669143061
  Medicare reassignment NPD
• Five Rivers Health Centers

  • Family Medicine Physician
  • Dayton, OH
  • NPI 1053600775
  NPD
• Five Rivers Health Centers

  • Family Medicine Physician
  • Xenia, OH
  • NPI 1083501415
  NPD

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1649851734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 MIAMI CHAPEL RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174650",
            "telephone_number": "937-901-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 MIAMI CHAPEL RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174650",
            "telephone_number": "937-281-6800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Childrens Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432052664",
            "country_code": "US",
            "telephone_number": "937-901-2777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROEKHUIS",
        "first_name": "NICHOLE",
        "credential": "RN, BSN, CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-185641",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP0036317",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.423570",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "1-185641",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Brocksmith, CRNA
• George T Broderick, MD
• Pamela Joy Broderick, M.D.
• Shawn Brodess
• Jason Brodnick
• Terra Lynn Broering, PA-C
• D. Richard Bromberg, PH.D.
• Diann M. Bromberg, LISW
• Tania Bronaugh
• Brondon Foot and Ankle LLC

• Pediatric Nurse Practitioner in Dayton, OH
• Providers in Dayton, OH by specialty
• Pediatric Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; 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.