Lizzeth Broadway

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

559684 Issued in CA

Practice address

800 N State College Blvd
Fullerton, CA 92831-3547

Phone

(657) 278-3040

NPI assigned

Feb 7, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lbroadway1257521@direct.llu.edu

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.

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  • NPI 1205009917
  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Body Imaging Physician
  • Rialto, CA
  • NPI 1700495363
  NPD
• California State University Fullerton

  • Community/Retail Pharmacy
  • Fullerton, CA
  • NPI 1730194366
  NPD (past)

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605916800000",
    "number": "1972842185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6830",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928346830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N STATE COLLEGE BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928313547",
            "telephone_number": "657-278-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWAY",
        "first_name": "LIZZETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-07",
        "last_updated": "2020-11-21",
        "certification_date": "2020-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "559684",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "559684",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2020; 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.