Provider Demographics
NPI:1083085286
Name:BRODUS, TEIONA (CNA)
Entity Type:Individual
Prefix:
First Name:TEIONA
Middle Name:
Last Name:BRODUS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2575
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29901-2575
Mailing Address - Country:US
Mailing Address - Phone:843-941-9131
Mailing Address - Fax:
Practice Address - Street 1:15 BEN MACK DR
Practice Address - Street 2:
Practice Address - City:SAINT HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920-6512
Practice Address - Country:US
Practice Address - Phone:843-941-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15341374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide