Individual
MELVA JUNE BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
6881 W STATE ST, #8, BOISE, ID 83714-7428
(208) 850-2653
Mailing address
6881 W STATE ST, #8, BOISE, ID 83714-7428
(208) 850-2653
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-33864
ID
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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