Provider Demographics
NPI:1720892078
Name:BRODAHL, NATOYA J
Entity type:Individual
Prefix:
First Name:NATOYA
Middle Name:J
Last Name:BRODAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-0280
Mailing Address - Country:US
Mailing Address - Phone:402-287-2281
Mailing Address - Fax:
Practice Address - Street 1:1033 E 23RD ST STE 7
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2448
Practice Address - Country:US
Practice Address - Phone:402-676-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist