Individual
BECKY ANN BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8200 WALNUT HILL LN, DALLAS, TX 75231-4426
(213) 345-7175
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(213) 345-7175
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
676092
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155545001
—
TX
01
—
430077685
RAILROAD MEDICARE
TX
01
—
82953U
BCBS TX
TX
Enumeration date
05/24/2006
Last updated
06/14/2010
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