Provider Demographics
NPI:1346234713
Name:DEROUSSEAU, RAMONA L (ARNP-C-MSN)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:L
Last Name:DEROUSSEAU
Suffix:
Gender:F
Credentials:ARNP-C-MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:BLDG. E-210
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-537-1414
Mailing Address - Fax:785-537-0623
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:BLDG. E-210
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-1414
Practice Address - Fax:785-537-0623
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100276980DMedicaid
KSS14890Medicare UPIN
KS161138Medicare ID - Type Unspecified