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General NPI Number Information
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NPI Number | 1467449975
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Entity Type | Individual
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Provider Name | MICHELE RACHEAL BROAD NP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 24910 LAS BRISAS ROAD STE 105
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City | MURRIETA
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State | CA
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Zip | 92562-4010
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Country | US
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Telephone | 951-231-1385
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Fax | 566-345-3272
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Provider Business Mailing Address
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Address Line | 6136 KETTLE FIRE TRL
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City | COLORADO SPRINGS
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State | CO
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Zip | 80925-1351
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Country | US
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Telephone | 951-533-6113
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 428809
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 428809
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License Number State | CA
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