Healthcare Provider Details

I. General information

NPI: 1891523775
Provider Name (Legal Business Name): ANGELA BROUSSARD AUGUSTUS CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 W 3RD ST
CROWLEY LA
70526-4816
US

IV. Provider business mailing address

5520 JOHNSTON ST STE K
LAFAYETTE LA
70503-5138
US

V. Phone/Fax

Practice location:
  • Phone: 337-250-2062
  • Fax:
Mailing address:
  • Phone: 337-250-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: