Andrea Broadnax
Private Vehicle in Fayetteville, NC. Individual provider (NPI-1).
NPI number1508225160
StatusActive
Last updated in NPPESNov 7, 2016
Details
- NPI
- 1508225160
- Entity type
- Individual (NPI-1)
- Name
- Andrea Broadnax
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 10, 2016
- Last updated
- Nov 7, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 347C00000X | Private Vehicle | – | NC | Yes |
| 251S00000X | Community/Behavioral Health | 2016-3437-01 | NC |
Practice location
3444 Bragg BlvdFayetteville, NC 28303-3946
Phone 910-286-7873
Mailing address
882 Southview CirFayetteville, NC 28311-0318
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