Individual
MRS. LUZ MARIA BROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
600 NE 8TH ST STE 300, GRESHAM, OR 97030-7318
(503) 988-8500
Mailing address
600 NE 8TH ST STE 300, GRESHAM, OR 97030-7318
(503) 988-8500
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201030226
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201030226LPN
LICENSE PRACTICAL NURSE
OR
Enumeration date
01/10/2011
Last updated
04/29/2019
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