Provider Demographics
NPI:1992769566
Name:BROELMANN, LUCILLE M (CRNA)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:M
Last Name:BROELMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:M
Other - Last Name:RECUPERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:9000 FRANKLIN SQUARE DR
Mailing Address - Street 2:2 NORTH
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3901
Mailing Address - Country:US
Mailing Address - Phone:443-777-7179
Mailing Address - Fax:443-777-8242
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:2 NORTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7179
Practice Address - Fax:443-777-8242
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000127367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAC000127OtherCRNA
MDAC000127OtherCRNA