Colleen Broderius

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

717706 Issued in WA

Practice address

8012 W Wild Rose Rd
Deer Park, WA 99006-9753

Phone

(509) 220-8914

Fax

(509) 220-8914

NPI assigned

Apr 30, 2026

Sex

Female

Sole proprietor

Yes

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, last updated by the provider on Apr 30, 2026.

{
    "created_epoch": "1777507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1992642763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8012 W WILD ROSE RD",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990069753",
            "telephone_number": "509-220-8914",
            "fax_number": "509-220-8914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8012 W WILD ROSE RD",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990069753",
            "telephone_number": "509-220-8914",
            "fax_number": "509-220-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERIUS",
        "first_name": "COLLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-30",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "717706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen D. Bichler, ARNP
• Samantha Birrell, OTR/L
• Ginger R Blake, ARNP
• Lacey Boggan
• Kayliann Marie Bowman, LMP
• Leslie Gambill Brost, PSYD
• Taylor J Broughton, PA-C
• Joshua Adams Bruns, LPC, LMHC
• Jeffrey N Burnham, ARNP
• Leonard Ray Campbell, RN

• All providers in Deer Park, WA
• Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; 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.