Healthcare Provider Details

I. General information

NPI: 1255732293
Provider Name (Legal Business Name): KATHLEEN BRODERICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN LOGAN

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAIN ST STE 206
NORTH READING MA
01864-2280
US

IV. Provider business mailing address

290 LITTLETON RD UNIT 3
CHELMSFORD MA
01824-3429
US

V. Phone/Fax

Practice location:
  • Phone: 617-905-1978
  • Fax:
Mailing address:
  • Phone: 978-258-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN282504
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: