Individual
PAULLA DANIELLE BROUILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7777 HENNESSY BLVD, OUR LADY OF THE LAKE MED CNTR -- ER DEPT, BATON ROUGE, LA 70808-4300
(888) 447-2450
(405) 341-9217
Mailing address
7777 HENNESSY BLVD, OUR LADY OF THE LAKE MED CNTR -- ER DEPT, BATON ROUGE, LA 70808-4300
(888) 447-2450
(405) 341-9217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200216
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1319376
—
LA
01
—
P00810364
RAILROAD THRU PEPA
—
Enumeration date
08/06/2008
Last updated
05/24/2013
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