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General NPI Number Information
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NPI Number | 1982726634
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Entity Type | Individual
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Provider Name | SAMUEL P BROUILLETTE C.P., C.F.O
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1524 ELIZABETH AVE
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City | CHARLOTTE
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State | NC
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Zip | 28204-2509
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Country | US
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Telephone | 704-334-1860
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Fax | 704-347-2785
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Provider Business Mailing Address
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Address Line | 1279 WILLOWBREEZE CT
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City | CONCORD
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State | NC
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Zip | 28025-8975
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Country | US
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Telephone | 980-622-8266
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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