Provider Demographics
NPI:1154562171
Name:BROOMFIELD, GEORGE FRANK SR (CNA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRANK
Last Name:BROOMFIELD
Suffix:SR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 ROCK MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-3576
Mailing Address - Country:US
Mailing Address - Phone:317-696-5380
Mailing Address - Fax:
Practice Address - Street 1:3556 ROCK MAPLE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-3576
Practice Address - Country:US
Practice Address - Phone:317-696-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA9814475376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide