Individual
ELIZABETH BROUILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA, APRN
Contact information
Practice address
1103 REGINA ST, LONGVIEW, TX 75605-1527
(903) 806-2373
Mailing address
1103 REGINA ST, LONGVIEW, TX 75605-1527
(903) 806-2373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2011029758
MO
363A00000X
Physician Assistant
Primary
—
—
363L00000X
Nurse Practitioner
2011029758
MO
Other
Enumeration date
04/29/2017
Last updated
10/11/2017
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