Individual
MS. DANIELLE ALISON BROUILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, AGACNP-BC, OCN
Contact information
Practice address
3485 S BOND AVE, PORTLAND, OR 97239-4503
(503) 494-8311
Mailing address
2314 SE 46TH AVE, PORTLAND, OR 97215-3738
(603) 380-1771
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202213884RN
OR
363LA2100X
Acute Care Nurse Practitioner
Primary
10002086
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002086
APRN LICENSE
OR
Enumeration date
11/09/2022
Last updated
01/11/2023
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