Individual
BENJAMIN PATRICK BROUILLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3600 JACKSON ST, ALEXANDRIA, LA 71303-3040
(318) 625-7050
Mailing address
120 HIDDEN PATH DR, PINEVILLE, LA 71360-2202
(318) 794-0419
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
0994
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0994
LAST FOUR
LA
Enumeration date
08/03/2022
Last updated
08/03/2022
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