Active NPI
Renae Marie Broders, RD, LMNT
- Registered Dietitian
- Norfolk, NE
National Provider Identifier
1669531620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 785
- Practice address
- 2700 W Norfolk Ave
Norfolk, NE 68701 - Phone
- (402) 371-4880
- Fax
- (402) 844-8129
- NPI assigned
- Dec 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 785 | NE | Primary |
Addresses
Primary practice location
2700 W Norfolk Ave
Norfolk, NE 68701
Mailing address
88559-544 Ave
Bloomfield, NE 68718
Phone (402) 371-4880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47079687563 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 785 | NE | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1669531620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "88559-544 AVE",
"city": "BLOOMFIELD",
"state": "NE",
"postal_code": "68718",
"telephone_number": "402-371-4880",
"fax_number": "402-844-8129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 W NORFOLK AVE",
"city": "NORFOLK",
"state": "NE",
"postal_code": "68701",
"telephone_number": "402-371-4880",
"fax_number": "402-844-8129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERS",
"first_name": "RENAE",
"middle_name": "MARIE",
"credential": "RD, LMNT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NE",
"license": "785",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47079687563",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.