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General NPI Number Information
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NPI Number | 1164534822
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Entity Type | Individual
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Provider Name | LORI A BRODSKY NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 175 US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9048
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Country | US
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Telephone | 207-885-7700
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Fax | 207-885-7701
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Provider Business Mailing Address
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Address Line | 39 WALLACE AVE
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6143
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Country | US
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Telephone | 207-761-0650
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Fax | 207-761-8198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R047235
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License Number State | ME
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