Individual
DONNA THOMPSON BROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC, CPNP, WHNP
Contact information
Practice address
1903 MULBERRY AVE, MOUNT PLEASANT, TX 75455-2369
(903) 572-2957
(903) 572-0696
Mailing address
1030 N ALLEN ST, ROCKPORT, TX 78382-3106
(903) 563-3057
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
516184
TX
363LW0102X
Women's Health Nurse Practitioner
Primary
516184
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102267501
—
TX
05
—
102267502
—
TX
01
—
86N522
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/19/2006
Last updated
03/21/2017
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