Individual
MS. MARLA BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
816 INDEPENDENCE BLVD, STE. 2A, VIRGINIA BEACH, VA 23455-6010
(757) 363-6230
(757) 363-6204
Mailing address
816 INDEPENDENCE BLVD, STE. 2A, VIRGINIA BEACH, VA 23455-6010
(757) 363-6230
(757) 363-6204
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024169450
VA
367500000X
Certified Registered Nurse Anesthetist
079980
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079980
CRNA LICENSE NUMBER
—
01
—
768704
TX NURSING LICENSE
TX
Enumeration date
01/13/2010
Last updated
06/15/2011
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