Provider Demographics
NPI:1003528464
Name:ROUSSEAU, ERIKA (RN)
Entity type:Individual
Prefix:MISS
First Name:ERIKA
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:ROUSSEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:263 SHELLBARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-1625
Mailing Address - Country:US
Mailing Address - Phone:561-201-4678
Mailing Address - Fax:
Practice Address - Street 1:263 SHELLBARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-1625
Practice Address - Country:US
Practice Address - Phone:561-201-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9412623163W00000X
374U00000X, 376J00000X, 376K00000X
GAPHCP011679163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide