Provider Demographics
NPI:1265617260
Name:BRODBECK, MAUREEN O'NEILL (RT (M))
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:O'NEILL
Last Name:BRODBECK
Suffix:
Gender:F
Credentials:RT (M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LAKE ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2103
Mailing Address - Country:US
Mailing Address - Phone:561-967-6535
Mailing Address - Fax:
Practice Address - Street 1:114 LAKE ARBOR DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2103
Practice Address - Country:US
Practice Address - Phone:561-967-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT117062471M2300X
MA142092471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography