Individual provider · Type 1 NPI

Madison Mackenzie Broderick

Student in an Organized Health Care Education/Training Program · Springfield, MO

NPI number 1740910868 Active

Practice location

901 S National Ave # PROF160
Springfield, MO 65897-0027

Call (417) 836-8553 Map

Mailing address

5203 Patterson Rd
St. Louis, MO 63129-2443

Specialties and licenses

TaxonomyCodeLicense
Athletic Trainer 2255A2300XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1740910868

Madison Mackenzie Broderick's National Provider Identifier is 1740910868, issued on Jun 13, 2022. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Springfield, MO. The record was last updated on Jun 16, 2022.