Individual
BREANNA JORDAN BROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1202 MEDICAL CENTER DR, WILMINGTON, NC 28401-7307
(910) 341-3459
(910) 343-0438
Mailing address
1202 MEDICAL CENTER DR, WILMINGTON, NC 28401-7307
(910) 617-6705
(910) 431-4048
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
5015119
NC
208VP0014X
Interventional Pain Medicine Physician
5015119
NC
363L00000X
Nurse Practitioner
Primary
5015119
NC
Other
Enumeration date
09/29/2021
Last updated
02/03/2023
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