Provider Demographics
NPI:1801070859
Name:BROUSSARD, CINDERELLA MARIE (RN)
Entity type:Individual
Prefix:
First Name:CINDERELLA
Middle Name:MARIE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 913
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-0913
Mailing Address - Country:US
Mailing Address - Phone:337-565-7026
Mailing Address - Fax:855-832-5335
Practice Address - Street 1:208 W GLORIA SWITCH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3409
Practice Address - Country:US
Practice Address - Phone:337-565-7026
Practice Address - Fax:855-832-5335
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA093861163WA0400X
LA09099363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)