Individual
TIA LEA BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1203 MAPLE ST, GREENSBORO, NC 27405-6910
(336) 840-5591
Mailing address
1203 MAPLE ST, GREENSBORO, NC 27405-6910
(336) 840-5591
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
218830
NC
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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