Individual
MRS. BONITA LORRAINE BROSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
538 DAHL DR, DE FOREST, WI 53532-1553
(608) 846-4165
Mailing address
538 DAHL DR, DE FOREST, WI 53532-1553
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
25344-031
WI
Other
Enumeration date
11/13/2011
Last updated
11/13/2011
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