Healthcare Provider Details

I. General information

NPI: 1750264628
Provider Name (Legal Business Name): JULIANNA BRODHECKER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 NJ-70 #101
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

209 HILLCREST AVE
NEPTUNE NJ
07753-5756
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-8000
  • Fax:
Mailing address:
  • Phone: 201-317-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberPENDING
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00092200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: