Individual
KATELYN BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(800) 789-7366
Mailing address
615 MILLER ST, PHILADELPHIA, PA 19125-2721
(443) 610-8755
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
26NR227227100
PA
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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