Provider Demographics
NPI:1609697374
Name:BROADHURST, REBECCA YU (A-GNP, WHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:YU
Last Name:BROADHURST
Suffix:
Gender:F
Credentials:A-GNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3907
Mailing Address - Country:US
Mailing Address - Phone:585-414-1319
Mailing Address - Fax:
Practice Address - Street 1:981 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3716
Practice Address - Country:US
Practice Address - Phone:857-231-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2373527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner