Provider Demographics
NPI:1730559964
Name:ROUSSELLE, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:ROUSSELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40430 E I55 SERVICE RD #40
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454
Mailing Address - Country:US
Mailing Address - Phone:985-507-4584
Mailing Address - Fax:
Practice Address - Street 1:40430 E I55 SVC RD #40
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454
Practice Address - Country:US
Practice Address - Phone:985-507-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN109592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse