Individual
SAMUEL P BROUILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P., C.F.O
Contact information
Practice address
1524 ELIZABETH AVE, CHARLOTTE, NC 28204-2509
(704) 334-1860
(704) 347-2785
Mailing address
1279 WILLOWBREEZE CT, CONCORD, NC 28025-8975
(980) 622-8266
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7700566
—
NC
05
—
7795145
—
NC
05
—
7795146
—
NC
Enumeration date
04/04/2007
Last updated
07/09/2007
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