MEDICARE: DR. NANCY ELAINE BROSKIE M.D.

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	2084P0800X	Psychiatry Physician	17967	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235120973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ELAINE BROSKIE M.D.

Provider Business Mailing Address
First Line	:	525 GLEN CREEK RD NW
Second Line	:	SUITE 240
City	:	SALEM
State	:	OR
Zip	:	97304-3161
Country	:	US
Telephone Number	:	503-364-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 GLEN CREEK RD NW
Second Line	:	SUITE 240
City	:	SALEM
State	:	OR
Zip	:	97304-3161
Country	:	US
Telephone Number	:	503-364-7049
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	11/21/2023

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