Provider Demographics
NPI:1073921946
Name:ROUSSEAU, GAIL ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ELIZABETH
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 GODWARD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1741
Mailing Address - Country:US
Mailing Address - Phone:612-353-4669
Mailing Address - Fax:612-354-2403
Practice Address - Street 1:1300 GODWARD ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1741
Practice Address - Country:US
Practice Address - Phone:612-353-4669
Practice Address - Fax:612-354-2403
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 058902-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse