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NPI Code Detail

MEDICARE: MARY E BROUGHTON PA-C

MEDICARE: MARY E BROUGHTON PA-C
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
1363AM0700XMedical Physician Assistant10288MN

General Provider Information

NPI Number : 1487844734
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E BROUGHTON PA-C
Provider Business Mailing Address
First Line : 9201 W BROADWAY AVE STE 601
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55445-1924
Country : US
Telephone Number : 763-587-7900
Fax Number : 763-587-7066
Provider Business Practice Location Address
First Line : 5109 36TH AVE N
Second Line :
City : CRYSTAL
State : MN
Zip : 55422-2007
Country : US
Telephone Number : 763-587-7900
Fax Number : 763-587-7989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2007
Last Update Date : 11/07/2022

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Directions to “ MARY E BROUGHTON PA-C” Practice Location

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