Individual
MRS. JESSICA BRODWOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3188 BENWICK DR, MEDINA, OH 44256-6452
(330) 410-6682
Mailing address
10278 FIRESTONE RD, HOMERVILLE, OH 44235-9728
(330) 410-6682
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
3878573
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3878573
—
OH
Enumeration date
12/30/2020
Last updated
12/30/2020
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