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General NPI Number Information
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NPI Number | 1104069335
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Entity Type | Organization
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Legal Business Name | KRISTIN BROUSSEAU, DO, PC
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 2501 WALNUT ST SUITE 108
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City | BOULDER
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State | CO
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Zip | 80302-5751
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Country | US
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Telephone | 720-223-7877
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Fax | 888-873-4912
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Provider Business Mailing Address
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Address Line | 2501 WALNUT ST SUITE 108
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City | BOULDER
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State | CO
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Zip | 80302-5751
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Country | US
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Telephone | 720-223-7877
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Fax | 888-873-4912
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Authorized Official
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Title or Position | PRESIDENT, SOLE PROPRIETOR
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Name | DR. KRISTIN M BROUSSEAU
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Credential | D.O.
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Telephone | 720-938-6720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 40799
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License Number State | CO
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