Provider Demographics
NPI:1073063475
Name:BROUGHTON, RITA (LPN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 N LOYOLA DR APT 243
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-7741
Mailing Address - Country:US
Mailing Address - Phone:985-502-0332
Mailing Address - Fax:
Practice Address - Street 1:4933 WABASH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1031
Practice Address - Country:US
Practice Address - Phone:504-780-2766
Practice Address - Fax:504-780-9699
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20142574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse