Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 26120 | IA |
N | 111NI0900X | Internist | 26120 | IA |
Y | 207RH0002X | Hospice and Palliative Medicine | 26120 | IA |
NPI | 1275521833 |
---|---|
Provider Name | Ann Broderick |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 17/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1140038 | (05) | IA |
27480 | WELLMARK BCBS (01) | IA |
E04884 | (02) |