Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 938479 | MN |
Y | 225700000X | Massage Therapist | MT-27885 | AZ |
NPI | 1285935726 |
---|---|
Provider Name | Ms. Muzique Latise Broadnax |
First Address | Phoenix, AZ 85034-1908 |
Second Address | Minneapolis, MN 55405-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2010 |
Last Update Date | 29/09/2021 |