Provider Demographics
NPI:1992238067
Name:BROADHEAD, ROBBI LEA (RN)
Entity type:Individual
Prefix:
First Name:ROBBI
Middle Name:LEA
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9188
Mailing Address - Country:US
Mailing Address - Phone:601-616-5152
Mailing Address - Fax:
Practice Address - Street 1:2103 13TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4045
Practice Address - Country:US
Practice Address - Phone:601-482-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858055163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator