Doctor Name: | MRS. JENNIFER DIANE BRODERSON |
NPI Number: | 1437313046 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T. |
License Number: | MAT10080 |
Business Practice Address: | 74-5620 Palani Rd Suite 102 Kailua Kona, HI - 967403640 |
Business Phone Number: | 8083297797 |
Business Fax Number: | 8083292748 |
Mailing Address: | 74-5620 Palani Rd, Suite 102 KAILUA KONA |
State: | HI |
Postal Code: | 967403640 |
Phone Number: | 8083297797 |
Fax Number: | 8083292748 |
NPI Enumeration Date: | 07/12/2008 |
NPI Last Update Date: | 07/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MAT10080 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |