MS. NANCY C BRADDOCK (NPI# 1437275252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437275252 |
| Entity Type | Individual |
| Full Name | MS. NANCY C BRADDOCK |
| Other Name | NANCY COSTELLO |
| Credential | PA-C |
| Practice Address |
311 W Lincoln St Ste 201 Belleville IL 62220-1902 |
| Mailing Address |
311 W Lincoln St Ste 101 Belleville IL 62220-1902 |
| Practice Telephone | 6182223200 |
| Practice Fax Number | 6182223203 |
| Mailing Telephone | 6182223200 |
| Mailing Fax Number | 6182223203 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2018-09-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085002020 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
2011035522 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
311 W LINCOLN ST STE 201 |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62220-1902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376530949 | John J Boeren | General Practice | 311 W Lincoln St, Suite 300, Belleville, IL 62220-1902 | 2005-09-29 |
| 1770042111 | Ahmed 15 LLC | Clinic/Center | 311 W Lincoln St, Belleville, IL 62220-1902 | 2019-03-15 |
| 1467803049 | Mallory Ann Butler | Nurse Practitioner | 311 W Lincoln St, Suite 100, Belleville, IL 62220-1902 | 2016-06-24 |
| 1275933756 | Belleville Surgical Center Ltd | Clinic/Center | 311 W Lincoln St, Suite 300, Belleville, IL 62220-1902 | 2014-09-03 |
| 1356760946 | Metro East Anesthesia LLC | Nurse Anesthetist, Certified Registered | 311 W Lincoln St, Ste 101, Belleville, IL 62220-1902 | 2014-04-10 |
| 1700218146 | Belleville Endoscopy Anesthesia | Anesthesiology | 311 W Lincoln St, Suite 100, Belleville, IL 62220-1902 | 2013-08-08 |
| 1851735450 | Mark S. Feldman, M.d. P.C. | Specialist | 311 W Lincoln St, Suite 100, Belleville, IL 62220-1902 | 2013-04-25 |
| 1497026686 | Belleville Endoscopy | Specialist | 311 W Lincoln St, Suite 100, Belleville, IL 62220-1902 | 2012-01-19 |
| 1770893919 | Robert Hellman Md. LLC | Anesthesiology | 311 W Lincoln St, Suite 300, Belleville, IL 62220-1902 | 2010-10-20 |
| 1215198973 | Cheryl L Kulik | Nurse Anesthetist, Certified Registered | 311 W Lincoln St, Ste 101, Belleville, IL 62220-1902 | 2008-06-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144729716 | St. Elizabeth's Hospital of The Hospital Sisters of The Third Order Of | Clinic/Center | 180 South Third Street Suite 101, Belleville, IL 62220 | 2018-02-08 |
| 1437675535 | Prorehab PC | Occupational Therapist | 1915 Carlyle Ave, Ste D, Belleville, IL 62220 | 2017-08-21 |
| 1629527650 | Arika Forrest | Nurse Practitioner | 140 Iowa Ave, Belleville, IL 62220 | 2016-10-03 |
| 1861861403 | Belleville Endoscopy LLC | Internal Medicine | 311 West Lincoln St, Suite 101, Belleville, IL 62220 | 2015-09-24 |
| 1962871558 | Antony Frierdich | Specialist/Technologist | 22 South 13th Street, Belleville, IL 62220 | 2015-09-24 |
| 1588032858 | Dana Wright | Pharmacist | 211 South Thrid Street, Belleville, IL 62220 | 2015-09-03 |
| 1629208731 | Lisa Marlow Johnson | Developmental Therapist | 34 Fenwood Dr, Belleville, IL 62220 | 2009-07-23 |
| 1841361623 | Neurological Surgery of Belleville | Neurological Surgery | 340 West Lincoln Street, Suite 540, Belleville, IL 62220 | 2006-11-13 |
| 1689769119 | Kathy Jo Corn | Counselor | 521 W. Main, Suite 201 B, Belleville, IL 62220 | 2006-10-03 |
| 1780609578 | Southern Illinois Health Care Foundation, Inc. | Counselor | 180 S 3rd St Ste 103&104, Belleville, IL 62220 | 2006-07-13 |
| Find all providers in zip 62220 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548657059 | Joseph Shipman | Physician Assistant | 13604 Pinewood Ln, Belleville, MI 48111-2030 | 2015-04-22 |
| 1811205750 | Lisa Renee Sullivan | Physician Assistant | 44305 Harmony Ln, Belleville, MI 48111-2449 | 2010-09-14 |
| 1366433286 | Janet P. Rudderham | Physician Assistant | 311 W Lincoln St Ste 101, Belleville, IL 62220-1902 | 2005-10-31 |
| 1396375788 | Emily Jean Sloan | Physician Assistant | 4500 Memorial Dr, Belleville, IL 62226-5360 | 2020-01-24 |
| 1639678451 | Allyson Leigh Peludat | Physician Assistant | 4600 Memorial Dr Ste W3, Belleville, IL 62226-5359 | 2018-02-07 |
| 1689188765 | Hill & Desire Healthcare Pllc | Physician Assistant | 25 Owen St, Belleville, MI 48111-2921 | 2017-11-28 |
| 1881138576 | Kathryn Elizabeth Markferding | Physician Assistant | 1 Clara Maass Dr, Belleville, NJ 07109-3550 | 2016-12-14 |
| 1427458454 | Jenny Kalina | Physician Assistant | 5 Franklin Ave, Belleville, NJ 07109-3532 | 2014-08-27 |
| 1013352558 | Lucknie Ovincy | Physician Assistant | 50 Newark Ave, Belleville, NJ 07109-1185 | 2013-05-09 |
| 1417203928 | Bhargavi Jitendra Patel | Physician Assistant | 1 Clara Maass Dr, Belleville, NJ 07109-3550 | 2012-08-02 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62220 |
Please comment or provide details below to improve the information on MS. NANCY C BRADDOCK.
| 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.