Provider Demographics
NPI:1528803970
Name:BROADNAX, YOLANDA DENISE (CRNP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:DENISE
Last Name:BROADNAX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 WOODHILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-1340
Mailing Address - Country:US
Mailing Address - Phone:334-391-9889
Mailing Address - Fax:
Practice Address - Street 1:3612 WOODHILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-1340
Practice Address - Country:US
Practice Address - Phone:334-391-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095576363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health