Individual
JENNIFER L BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAREGIVER
Contact information
Practice address
79 W MAIN ST, LEXINGTON, OH 44904-1113
(419) 884-1302
(419) 884-8398
Mailing address
79 W MAIN ST, LEXINGTON, OH 44904-1113
(419) 884-1302
(419) 884-8398
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2539088
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2539088
—
OH
Enumeration date
06/29/2006
Last updated
07/09/2007
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