| Doctor Name: | MR. NICHOLAS PAUL BROUSSARD |
| NPI Number: | 1578755104 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNA |
| License Number: | RN108764 |
| Business Practice Address: | 5113 La Premiere Dr Maurice, LA - 705553764 |
| Business Phone Number: | 3372780037 |
| Business Fax Number: | |
| Mailing Address: | 5113 La Premiere Dr, MAURICE |
| State: | LA |
| Postal Code: | 705553764 |
| Phone Number: | 3372780037 |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2007 |
| NPI Last Update Date: | 10/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0200X |
| License Number: | RN108764 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Critical Care Medicine |
| Taxonomy Definition: | |