Provider Demographics
NPI:1255147542
Name:BROUSSEAU, HEIDI S (PRENATAL DOULA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:BROUSSEAU
Suffix:
Gender:F
Credentials:PRENATAL DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ANNAWAMSCUTT RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1930
Mailing Address - Country:US
Mailing Address - Phone:401-486-6387
Mailing Address - Fax:
Practice Address - Street 1:26 ANNAWAMSCUTT RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1930
Practice Address - Country:US
Practice Address - Phone:401-486-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI201280374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula