Provider Demographics
NPI:1740588003
Name:BROUSSARD, SUSAN LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEE
Last Name:BROUSSARD
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:4650 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE 206
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6926
Mailing Address - Country:US
Mailing Address - Phone:337-988-2345
Mailing Address - Fax:337-988-2353
Practice Address - Street 1:4650 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:STE 206
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6926
Practice Address - Country:US
Practice Address - Phone:337-988-2345
Practice Address - Fax:337-988-2353
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LARN107720-AP06410363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics