Provider Demographics
NPI:1477075315
Name:ROUSSEAU, ANNEMARIE (APRN)
Entity Type:Individual
Prefix:DR
First Name:ANNEMARIE
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 S 450 E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:UT
Mailing Address - Zip Code:84078-8856
Mailing Address - Country:US
Mailing Address - Phone:435-828-1468
Mailing Address - Fax:
Practice Address - Street 1:2917 S 450 E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:UT
Practice Address - Zip Code:84078-8856
Practice Address - Country:US
Practice Address - Phone:435-828-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9087991-3102163WD0400X
UT9087991-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator