Provider Demographics
NPI:1730549163
Name:BROADWAY, DOROTHY M (CNA)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:M
Last Name:BROADWAY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4610
Mailing Address - Country:US
Mailing Address - Phone:870-732-7981
Mailing Address - Fax:870-732-7984
Practice Address - Street 1:130 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4610
Practice Address - Country:US
Practice Address - Phone:870-732-7981
Practice Address - Fax:870-732-7984
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2025-03-14
Deactivation Date:2019-03-29
Deactivation Code:
Reactivation Date:2025-03-14
Provider Licenses
StateLicense IDTaxonomies
AR208584752172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker