Individual
LAURA KAY BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1755 N BARKER RD, BROOKFIELD, WI 53045-1801
(262) 821-3939
Mailing address
921 N EVERGREEN CIR, HARTLAND, WI 53029-8636
(262) 369-9011
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
722026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40649500
—
WI
01
—
722026
STATE LICENSE
WI
Enumeration date
12/11/2008
Last updated
12/11/2008
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