Individual
SHANA MARIE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10404 TUCKER RD # LLC, VANCLEAVE, MS 39565-7922
(228) 354-9505
Mailing address
4511 LYNN DR, BILOXI, MS 39532-9477
(228) 860-1773
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903748
MS
Other
Enumeration date
05/05/2020
Last updated
06/24/2020
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