Individual
KEITH BRODEUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 MAPLE ST, HOLYOKE, MA 01040-5144
(413) 420-2200
Mailing address
230 MAPLE ST, HOLYOKE, MA 01040-5144
(413) 420-2200
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN2305966
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110027773
—
MA
Enumeration date
07/22/2016
Last updated
07/22/2016
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