Shana Marie Broussard
NPI #1134740798 in Vancleave, Mississippi
Provider Information
- NPI Number
- 1134740798
- Entity Type
- Individual
- Name
- Shana Marie Broussard
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Nurse Practitioner - Family
- Enumeration Date
- May 5, 2020
- Last Updated
- Jun 24, 2020
Practice Location
- Address
- 10404 TUCKER RD # LLC
- City
- Vancleave
- State
- Mississippi
- ZIP Code
- 39565-7922
- Phone
- (228) 354-9505
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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