| Doctor Name: | JEANETTA MARIE BROADWAY |
| NPI Number: | 1295136224 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 4014 Autumn Springs Cv Memphis, TN - 381252647 |
| Business Phone Number: | 9012795289 |
| Business Fax Number: | |
| Mailing Address: | 4014 Autumn Springs Cv, None MEMPHIS |
| State: | TN |
| Postal Code: | 381252647 |
| Phone Number: | 9012795289 |
| Fax Number: | |
| NPI Enumeration Date: | 09/09/2014 |
| NPI Last Update Date: | 09/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 172A00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Driver |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |