Provider Demographics
NPI:1316644727
Name:ROUSSEAU, JULIETTE HELENE (CRNA)
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:HELENE
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SAINT ALBANS CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1386
Mailing Address - Country:US
Mailing Address - Phone:919-475-4545
Mailing Address - Fax:
Practice Address - Street 1:14 SAINT ALBANS CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1386
Practice Address - Country:US
Practice Address - Phone:919-475-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC7298367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program