Provider Demographics
NPI:1962820787
Name:BBROUDY, GAYLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:
Last Name:BBROUDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2504
Mailing Address - Country:US
Mailing Address - Phone:843-886-6786
Mailing Address - Fax:
Practice Address - Street 1:119 SPARROW DR
Practice Address - Street 2:
Practice Address - City:ISLE OF PALMS
Practice Address - State:SC
Practice Address - Zip Code:29451-2504
Practice Address - Country:US
Practice Address - Phone:843-886-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00085947163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse