MS. MARY RACHELLE BRODERICK


Address: 6419 Lake Rd, Appleton, NY 14008-9606
Phone: 7162970798

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 124Q00000X Dental Hygienist 016112-1 NY Dental Providers

Other Provider Identifier

State Issuer Identifier Type Code
NY NEW YORK STATE LICENSE 016112-1 01

Other Providers MARY BRODERICK

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

Office Location

Street Address 6419 LAKE RD
City APPLETON
State NY
Zip Code 14008-9606

Providers in the same zip code

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

Providers in the same city

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
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Taxonomy Information

Taxonomy Code 124Q00000X
Grouping Dental Providers
Classification Dental Hygienist

Taxonomy Definition

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.

Providers in the same taxonomy and city

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
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Competitor

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City APPLETON
Zip Code 14008

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Dataset Information

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.

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