Individual
MS. BROOKE DELHOMME BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10101 PARK ROWE AVE, STE. 200, BATON ROUGE, LA 70810-1686
(225) 769-2200
(225) 768-2185
Mailing address
PO BOX 98509, BATON ROUGE, LA 70884-9509
(225) 769-2200
(225) 768-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200676
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2355261
—
LA
Enumeration date
12/16/2013
Last updated
04/19/2017
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