Individual
MR. ANDREA BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
406 PASS RD, GULFPORT, MS 39507
(286) 699-8402
Mailing address
406 PASS RD, GULFPORT, MS 39507-2901
(286) 699-9840
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
—
172A00000X
Driver
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104736701
—
MS
Enumeration date
01/09/2017
Last updated
02/01/2019
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