Individual
MARY JO BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1541 TULANE AVE, NEW ORLEANS, LA 70112-2821
(504) 903-1301
Mailing address
1541 TULANE AVE, NEW ORLEANS, LA 70112-2821
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
046359-3340
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046359-3340
STATE BOARD NURSING
LA
Enumeration date
05/23/2007
Last updated
07/08/2007
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