MS. MARY RACHELLE BRODERICK (NPI# 1134401490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1134401490 |
Entity Type | Individual |
Full Name | MS. MARY RACHELLE BRODERICK |
Credential | RDH |
Practice Address |
6419 Lake Rd Appleton NY 14008-9606 |
Practice Telephone | 7162970798 |
Practice Fax Number | 7162970998 |
Mailing Telephone | 7162970798 |
Mailing Fax Number | 7162970998 |
Enumeration Date | 2011-09-13 |
Last Update Date | 2011-09-13 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 016112-1 | NY | Dental Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NY | NEW YORK STATE LICENSE | 016112-1 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699057679 | Mary Kathleen Broderick | Speech-Language Pathologist | 25 Van Rensselaer Dr, Rensselaer, NY 12144-1491 | 2011-09-15 |
1356484240 | Mary Ellen Broderick | Psychologist | 2902 Madison St, Marianna, FL 32446-3450 | 2007-02-14 |
Street Address |
6419 LAKE RD |
City | APPLETON |
State | NY |
Zip Code | 14008-9606 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205054442 | Podiatry Solutions of Wny | Podiatrist | 6040 Edwards Aevnue, Newfane, NY 14008-1009 | 2007-04-23 |
1417322686 | Cazenovia Recovery Systems, Inc. | Substance Abuse Rehabilitation Facility | 7397 Lake Rd, Appleton, NY 14008-9612 | 2015-12-14 |
1184940686 | Willcare | Home Health | 7852 Town Line Rd, Appleton, NY 14008-9622 | 2010-04-09 |
1083038319 | John Strong | Nurse Anesthetist, Certified Registered | 7393 Bishop Rd, Appleton, NY 14008-9633 | 2014-02-06 |
1235657404 | Deborah Jones | Registered Nurse | 2583 Bishop Rd, Appleton, NY 14008-9665 | 2017-09-07 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922609692 | Tanya Rosenthal | Health Educator | W4991 Wege Rd, Appleton, WI 54913-8354 | 2020-11-08 |
1043811409 | Kristen T Razner | Physician Assistant | 2500 E Capitol Dr # 3700, Appleton, WI 54911-8735 | 2020-11-03 |
1487254108 | Samantha Lee Roberts | Speech-Language Pathologist | 3311 E Parkside Blvd Apt 125, Appleton, WI 54915-5631 | 2020-10-30 |
1104426477 | St Gianna Molla Clinic, Inc | Family Medicine | 20 Pinewild Ct, Appleton, WI 54913-7127 | 2020-10-27 |
1427657329 | Tyler John Friis | Specialist/Technologist | 1514 E Keystone Ln, Appleton, WI 54913-7162 | 2020-10-21 |
1336747781 | Daily Care Telemdicine Inc | Clinic/Center | 323 N Morrison St, Appleton, WI 54911-5404 | 2020-10-16 |
1659979359 | Venetia Lea Daniels | Registered Nurse | 1201 E Park Ridge Ave, Appleton, WI 54911-1568 | 2020-10-14 |
1659986677 | Jordana Butler | Physician Assistant | 2105 E Enterprise Ave # 101, Appleton, WI 54913-7862 | 2020-09-15 |
1518572429 | Claire Schuh | Social Worker | 3416 Association Ln, Appleton, WI 54914 | 2020-09-09 |
1073127049 | Dana Van De Hey | Physician Assistant | 616 White Birch Ct, Appleton, WI 54915-4516 | 2020-09-07 |
Find all providers in APPLETON |
Taxonomy Code | 124Q00000X |
Grouping | Dental Providers |
Classification | Dental Hygienist |
An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801400379 | Danielle L Shannon | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2020-09-02 |
1962034785 | Magdalena Skorupa | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2020-02-10 |
1710490339 | Olivia Jacobs | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2017-11-06 |
1508384033 | Macall Schmelzer | Dental Hygienist | 4182 W Wisconsin Ave, Appleton, WI 54913-8652 | 2017-09-05 |
1669997318 | Wendy Bekx | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2017-08-03 |
1992237838 | Tracey Losse | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2017-03-30 |
1720535289 | Jamie Baxter | Dental Hygienist | 4182 W Wisconsin Ave, Appleton, WI 54913-8652 | 2016-09-01 |
1033566518 | Ashley Schider | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2016-05-16 |
1922472950 | Michele Evers | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2015-11-13 |
1346623212 | Karly Kilgas | Dental Hygienist | 5337 W Grande Market Dr, Appleton, WI 54913-8442 | 2015-07-09 |
Find all providers in APPLETON |
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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.