Broussard, Mary Jo

Broussard, Mary Jo is an individual health care provider with primary practice located at 1541 Tulane Ave , New Orleans LA 70112-2821. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Broussard, Mary Jo can be contacted via phone (504) 903-1301.

Contact Information

Primary practice address
1541 Tulane Ave New Orleans LA 70112-2821
Phone: (504) 903-1301
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 046359-3340 Louisiana

Profile Details

NPI number 1285844571
LBN Legal business name Broussard, Mary Jo
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285844571 NPPES
Louisiana Other 046359-3340 STATE BOARD NURSING

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