Organization
CINDERELLA BROUSSARD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDERELLA MARIE BROUSSARD PMHNP (OWNER)
(337) 886-3151
Entity
Organization
Contact information
Practice address
208 W GLORIA SWITCH RD # 6, LAFAYETTE, LA 70507-3409
(337) 565-7026
(855) 832-5335
Mailing address
PO BOX 913, CARENCRO, LA 70520-0913
(337) 886-3151
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP09099
LA
Other
Enumeration date
02/02/2017
Last updated
01/11/2020
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