Jennifer L Broderick, CAREGIVER
Individual provider Active NPI Contractor · Lexington, OH
NPI 1144258807 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1144258807
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 2539088 (OH)
- Practice address
- 79 W Main St
Lexington, OH 44904-1113 - Phone
- (419) 884-1302
- Fax
- (419) 884-8398
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2539088 | OH | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 2539088 | OH | Yes |
Addresses
Primary practice location
79 W Main St
Lexington, OH 44904-1113
Mailing address
79 W Main St
Lexington, OH 44904-1113
Phone (419) 884-1302
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2539088 | Medicaid | OH |
Other providers in Lexington, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.