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NPI Code Detail

MEDICARE: MRS. BETTINA L BROUGHTON NP

MEDICARE: MRS. BETTINA L BROUGHTON NP
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
1363L00000XNurse PractitionerF430512-1NY
2363LA2100XAcute Care Nurse Practitioner430512NY

Other Identifiers

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

General Provider Information

NPI Number : 1831401314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETTINA L BROUGHTON NP
Provider Business Mailing Address
First Line : 2615 CULVER RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14609-1716
Country : US
Telephone Number : 585-336-5320
Fax Number : 585-697-1598
Provider Business Practice Location Address
First Line : 2615 CULVER RD
Second Line : 100
City : ROCHESTER
State : NY
Zip : 14609-1716
Country : US
Telephone Number : 585-336-5320
Fax Number : 585-697-1598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2010
Last Update Date : 11/20/2019

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