Provider Demographics
NPI:1770618019
Name:BRODERICK, KAREN ANN (LVN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:SLAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 BOURBON LN
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6802
Mailing Address - Country:US
Mailing Address - Phone:707-468-5869
Mailing Address - Fax:
Practice Address - Street 1:1120 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6340
Practice Address - Country:US
Practice Address - Phone:707-472-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN157238164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse