Provider Information for 1932394046
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Mrs. KIMBER ANN BROKAW L.I.S.W
Sex: Female
NPI: 1932394046
Last Updated: 2015-03-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1932394046 | ||||||||
| Enumeration Date | 2007-09-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 164 15TH AVE MOLINE, IL 61265-2925 United States Phone: 309-269-8810 | Fax: | ||||||||
| Primary Practice Address | 1035 LINCOLN RD SUITE 202 BETTENDORF, IA 52722-4198 United States Phone: 563-424-7137 | Fax: | ||||||||
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