Healthcare Provider Details

I. General information

NPI: 1225596497
Provider Name (Legal Business Name): YVETTE HARDY BROUSSARD RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4367
US

IV. Provider business mailing address

1513 BERWICK BND
ZACHARY LA
70791-5445
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6565
  • Fax:
Mailing address:
  • Phone: 225-454-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN116986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: