Nicole Broderson LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MB2485490 Issued in NM

Legal business name

NICOLE BRODERSON LLC

Practice address

1421 Luisa St
Suite N
Santa Fe, NM 87505-4073

Phone

(505) 428-0072

Fax

(888) 256-1158

NPI assigned

Feb 27, 2012

Last updated

Jul 31, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Nicole R Broderson, CNPNPI 1124308689

Title

Nurse Practitioner

Phone

(505) 428-0072

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Broderson, RN, MSN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Santa Fe, NM
  • NPI 1124308689
  NPD (past) Authorized official

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1932473741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 LUISA ST",
            "address_2": "SUITE N",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054073",
            "telephone_number": "505-428-0072",
            "fax_number": "888-256-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 LUISA ST",
            "address_2": "SUITE N",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054073",
            "telephone_number": "505-428-0072",
            "fax_number": "888-256-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE BRODERSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "BRODERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "505-428-0072",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "MB2485490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah A. Nicholas, M.D.
• Carla Nichols
• Todd Nichols, LPCC
• Darcy A Nicholson, L.M.T.
• Nico Ortiz Holistic Counseling and Wellness LLC
• Karen Nielsen, RN
• Nightingale Nursing and Home Health LLC
• Renee L. Nix, DN
• Ellen Njus
• Belinda Bershu Nkaime, PMHNP

• Mental Health Counselor in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; 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.