Individual
MR. NICHOLAS PAUL BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5113 LA PREMIERE DR, MAURICE, LA 70555-3764
(337) 278-0037
Mailing address
5113 LA PREMIERE DR, MAURICE, LA 70555-3764
(337) 278-0037
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN108764
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP05366
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1315397
—
LA
Enumeration date
08/17/2007
Last updated
10/09/2015
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