Healthcare Provider Details

I. General information

NPI: 1992589485
Provider Name (Legal Business Name): CHERISH RACHELLE BRODBECK MSN, RNC-OB, EMT-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12111 CR 2150
LUBBOCK TX
79404-8316
US

IV. Provider business mailing address

12111 CR 2150
LUBBOCK TX
79404-8316
US

V. Phone/Fax

Practice location:
  • Phone: 972-965-6973
  • Fax:
Mailing address:
  • Phone: 972-965-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number710353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: