Provider Demographics
NPI:1669368536
Name:BRODERICK, STARR N
Entity type:Individual
Prefix:
First Name:STARR
Middle Name:N
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STARR
Other - Middle Name:N
Other - Last Name:SAFRANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1356 S 196TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2954
Mailing Address - Country:US
Mailing Address - Phone:402-871-3116
Mailing Address - Fax:
Practice Address - Street 1:1356 S 196TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2954
Practice Address - Country:US
Practice Address - Phone:402-871-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant