SUSAN BROADWAY (NPI# 1154708956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154708956 |
| Entity Type | Individual |
| Full Name | SUSAN BROADWAY |
| Credential | R.N., N.P. |
| Practice Address |
1 Cyclotron Rd Ms26r0143 Berkeley CA 94720-8099 |
| Practice Telephone | 5104866951 |
| Practice Fax Number | 5104867192 |
| Mailing Telephone | 5104866951 |
| Mailing Fax Number | 5104867192 |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
332697 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
332697 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1 CYCLOTRON RD MS26R0143 |
| City | BERKELEY |
| State | CA |
| Zip Code | 94720-8099 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548480122 | Peter Douglass Lichty | Preventive Medicine | 1 Cyclotron Rd, Mailstop 26r0143, Berkeley, CA 94720-8239 | 2007-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609352798 | Richard Phan | Optometrist | 200 Minor Ln, Berkeley, CA 94720 | 2018-07-12 |
| 1184082067 | Carmen Lee | Registered Nurse | 2222 Bancroft Way, Mc4300, Berkeley, CA 94720 | 2016-02-05 |
| 1922355148 | Cynthia Medina | Counselor | 2222 Bancroft Way #4300, Berkeley, CA 94720 | 2012-08-07 |
| 1811199615 | Ellen De Neef | Physical Therapist | 2222 Bancroft, Berkeley, CA 94720 | 2007-06-04 |
| 1427185529 | Margaret Anne Fisher | Nurse Practitioner | 2222 Bancroft Ave, Berkeley, CA 94720 | 2007-02-27 |
| 1619049285 | Vikki V. Yu | Optometrist | 230 Minor Hall, Uc Berkeley School of Optometry, Berkeley, CA 94720 | 2006-11-15 |
| 1801992755 | Robert K Osborne Dds & Assoc Inc | Dentist | 1177 South Main St, North Canton, OH 94720 | 2006-09-16 |
| 1154949899 | Thuy-trang Nguyen | Optometrist | 230 Minor Hall, Berkeley, CA 94720 | 2020-07-09 |
| 1619498656 | Celia R Gong | Optometrist | 230 Minor Hall, Berkeley, CA 94720 | 2017-06-29 |
| 1790234680 | Kelsey Lindquist | Specialist/Technologist | 185 Haas Pavilion, Berkeley, CA 94720 | 2016-10-03 |
| Find all providers in zip 94720 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083081608 | Olivia Debree | Nurse Practitioner | 3075 Adeline Street, Suite 280, Lifelong Medical Care, Ashby Health Center, Berkeley, CA 94703 | 2015-08-31 |
| 1790048767 | Yonis Ahmed Mudey | Nurse Practitioner | 2288 Fulton St Ste 309, Berkeley, CA 94704-1490 | 2012-06-24 |
| 1770764987 | Kevin L Joiner | Nurse Practitioner | 2001 Dwight Way # 1388, Berkeley, CA 94704-2608 | 2007-11-15 |
| 1043760705 | Denise Scholz | Nurse Practitioner | 3260 Sacramento St, Berkeley, CA 94702-2739 | 2016-10-06 |
| 1679944169 | Melanie Marusczak | Nurse Practitioner | 3075 Adeline St, Ste 280, Berkeley, CA 94703-2576 | 2015-10-09 |
| 1013316488 | Maki Matsumura | Nurse Practitioner | 1510 4th St, Suite 1, Berkeley, CA 94710-1717 | 2014-08-21 |
| 1851669386 | Helen Horvath | Nurse Practitioner | 3260 Sacramento St, Berkeley, CA 94702-2739 | 2011-12-12 |
| 1700029105 | Quan Thai | Nurse Practitioner | 2001 Dwight Way, Alta Bates Comprehensive Cancer Center, Berkeley, CA 94704-2608 | 2009-04-14 |
| 1487860987 | Kathleen Ann Ruel | Nurse Practitioner | 1497 Alcatraz Ave, Berkeley, CA 94702-2710 | 2007-05-14 |
| 1023130622 | Laurel Jean Olslund | Nurse Practitioner | 2450 Ashby Ave, Berkeley, CA 94705-2067 | 2007-04-04 |
| Find all providers in BERKELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.