Provider Demographics
NPI:1427064542
Name:ROUSSEAU, JULIE K (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3360
Mailing Address - Country:US
Mailing Address - Phone:401-467-3115
Mailing Address - Fax:401-785-8468
Practice Address - Street 1:857 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3360
Practice Address - Country:US
Practice Address - Phone:401-467-3115
Practice Address - Fax:401-785-8468
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICNPP37217363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057338Medicare ID - Type Unspecified
RIQ36251Medicare UPIN