Most Relevant Information
Provider Data
| NPI Number: | 1003573262 |
| Provider Name: | BRANDY BROUSSARD |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/23/2021 |
| Last Updated: | 11/23/2021 |
Provider Practice Location
5850 FLORIDA BLVD
BATON ROUGE
LA
708064247
Practice Location Phone/Fax
| Phone: | 2252010696 |
| Fax: |
Provider Mailing Location
5850 FLORIDA BLVD
BATON ROUGE
LA
708064247
Provider Mailing Phone/Fax
| Phone: | 2252010696 |
| Fax: |