Individual
LAURA V BROUILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
580 W COLLEGE AVE, MARQUETTE, MI 49855-2705
(906) 228-9440
Mailing address
235 BALSAM LN, ISHPEMING, MI 49849-2710
(906) 485-1043
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704229292
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104865802
—
MI
01
—
LA075196
BLUESHIELD PIN
MI
Enumeration date
10/20/2006
Last updated
02/21/2013
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