MEDICARE: STEPHANIE LAUREN BRODERICK CNM, WHNP-BC

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	209013055	IL

General Provider Information

NPI Number	:	1629444823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LAUREN BRODERICK CNM, WHNP-BC

Provider Business Mailing Address
First Line	:	400 N HIGHLAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-3814
Country	:	US
Telephone Number	:	630-892-4355
Fax Number	:	630-892-0262

Provider Business Practice Location Address
First Line	:	1400 INDIAN AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505-3137
Country	:	US
Telephone Number	:	630-892-4355
Fax Number	:

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	05/10/2022

Similar Medicare Providers

1740901487 — EMMA SLAS DNP, CPNP-PC
Practice Location Address:

1400 INDIAN AVE
AURORA, IL
60505-3137

Practice Phone: 630-526-7912
Practice Fax:

1962214213 — ELIZABETH KOCH CD,(DONA)
Practice Location Address:

1400 INDIAN AVE
AURORA, IL
60505-3137

Practice Phone: 630-892-4355
Practice Fax:

1306877311 — SUN AND MOON CLINIC INC
Practice Location Address:

11175 E MISSISSIPPI AVE STE 232
AURORA, CO
80012-3137

Practice Phone: 303-340-8977
Practice Fax:

1639211451 — STEPHANIE L. PENROSE, M.D., P.C.
Practice Location Address:

11175 E MISSISSIPPI AVE STE 210
AURORA, CO
80012-3137

Practice Phone: 303-797-7227
Practice Fax: 303-797-8448

1194846667 — MISSISSIPPI DENTAL GROUP P.C.
Practice Location Address:

11175 E MISSISSIPPI AVE , SUITE 110
AURORA, CO
80012-3137

Practice Phone: 303-343-9313
Practice Fax: 303-343-9537

1639323496 — CLINICA DENTAL LATINA
Practice Location Address:

11175 E MISSISSIPPI AVE , SUITE 100
AURORA, CO
80012-3137

Practice Phone: 303-364-9831
Practice Fax: 303-364-7985

Directions to “ STEPHANIE LAUREN BRODERICK CNM, WHNP-BC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.