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MR. ROBERT ELLIS BROUILLETTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1057 PAUL MAILLARD RD, LULING, LA 70070-4349
(985) 785-6242
Mailing address
5024 TOBY LN, KENNER, LA 70065-3262
(504) 456-9958

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN041094APO1427
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1904765
LA
Enumeration date
01/09/2007
Last updated
02/27/2015
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