Individual
BRAKEISHA LASHAY BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
312 LISTON ST, LAFAYETTE, LA 70501-1040
(337) 565-9737
Mailing address
312 LISTON ST, LAFAYETTE, LA 70501-1040
(337) 565-9737
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
352464
TX
Other
Enumeration date
04/13/2020
Last updated
04/13/2020
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