Provider Demographics
NPI:1851869093
Name:BROSSARD, REBECCA (RN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BROSSARD
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:CHENAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19 CREEKWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-8809
Mailing Address - Country:US
Mailing Address - Phone:501-208-4631
Mailing Address - Fax:
Practice Address - Street 1:411 LENTZ RD
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-3740
Practice Address - Country:US
Practice Address - Phone:501-354-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR093550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse