Individual
LUISA BRODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
902 N ALMON ST APT 3, MOSCOW, ID 83843-8544
(509) 675-3813
Mailing address
615 E 9TH AVE, COLVILLE, WA 99114-9463
(509) 675-3813
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UDWW750166632
REGENCE
WA
Enumeration date
07/14/2020
Last updated
07/14/2020
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