MEDICARE: GEORGE FRANK BROOMFIELD SR. C.N.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	CNA9814475	IN

General Provider Information

NPI Number	:	1154562171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE FRANK BROOMFIELD SR. C.N.A

Provider Business Mailing Address
First Line	:	3556 ROCK MAPLE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-3576
Country	:	US
Telephone Number	:	317-696-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	3556 ROCK MAPLE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-3576
Country	:	US
Telephone Number	:	317-696-5380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	03/20/2009

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Directions to “ GEORGE FRANK BROOMFIELD SR. C.N.A” Practice Location

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