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General NPI Number Information
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NPI Number | 1346948882
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Entity Type | Individual
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Provider Name | LAUREN E BROADBENT
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Gender | Female
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | MSC10 5610 UNIVERSITY OF NEW MEXICO
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-272-4161
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Fax | 505-272-2776
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Provider Business Mailing Address
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Address Line | 17450 GROVELAND PL
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City | WAYZATA
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State | MN
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Zip | 55391-2880
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Country | US
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Telephone | 952-687-1032
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RS2025-0138
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License Number State | NM
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