Individual
JANESSA MARIE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
470 CASTRO ST, SAN FRANCISCO, CA 94114-2482
(415) 581-1600
(415) 581-1610
Mailing address
470 CASTRO ST, SAN FRANCISCO, CA 94114-2482
(415) 581-1600
(415) 581-1610
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95007103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95007103
NP LICENSE
CA
Enumeration date
08/04/2017
Last updated
12/13/2018
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