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General NPI Number Information
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NPI Number | 1740588003
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Entity Type | Individual
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Provider Name | SUSAN LEE BROUSSARD APRN
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Gender | Female
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 345 DOUCET RD STE 233
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City | LAFAYETTE
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State | LA
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Zip | 70503-3490
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Country | US
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Telephone | 337-257-5157
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Fax |
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Provider Business Mailing Address
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Address Line | 345 DOUCET RD STE 233
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City | LAFAYETTE
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State | LA
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Zip | 70503-3490
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Country | US
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Telephone | 337-257-5157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP06410
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN107720-AP06410
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License Number State | LA
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