Most Relevant Information
Provider Data
| NPI Number: | 1003434283 |
| Provider Name: | LUISA BRODEN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/14/2020 |
| Last Updated: | 07/14/2020 |
Provider Practice Location
902 N ALMON ST APT 3
MOSCOW
ID
838438544
Practice Location Phone/Fax
| Phone: | 5096753813 |
| Fax: |
Provider Mailing Location
615 E 9TH AVE
COLVILLE
WA
991149463
Provider Mailing Phone/Fax
| Phone: | 5096753813 |
| Fax: |