Provider Demographics
NPI:1144926973
Name:ROUSSE, EMILY KATE (RNFA, RNAS-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATE
Last Name:ROUSSE
Suffix:
Gender:F
Credentials:RNFA, RNAS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33808 SLAVENS RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OR
Mailing Address - Zip Code:97053-9517
Mailing Address - Country:US
Mailing Address - Phone:503-522-7388
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 18TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2516
Practice Address - Country:US
Practice Address - Phone:503-542-4888
Practice Address - Fax:503-542-2813
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200441371RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200441371RNOtherOREGON NURSING LICENSE
1765478OtherCNOR
R80383OtherRNAS-C