Individual
MRS. SHELLY BROUSSARD GILBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1757 IMPERIAL BLVD., LAKE CHARLES, LA 70605
(337) 310-2832
Mailing address
13523 BARRETT PARKWAY DRIVE, SUITE 104, BALLWIN, MO 63021-3802
(636) 938-6868
(636) 938-1486
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN071326
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4B584
MEDICARE SERVICES PART B
LA
Enumeration date
02/01/2007
Last updated
08/17/2010
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