Provider Demographics
NPI:1770915845
Name:BROOME, ROBERT JULIAN III (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JULIAN
Last Name:BROOME
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 BURNING EMBERS LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-8811
Mailing Address - Country:US
Mailing Address - Phone:704-597-3500
Mailing Address - Fax:
Practice Address - Street 1:8601 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4353
Practice Address - Country:US
Practice Address - Phone:704-597-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse