Provider Demographics
NPI:1689669152
Name:ROUSELLE, DIONNE M (MD)
Entity Type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:M
Last Name:ROUSELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2934
Mailing Address - Country:US
Mailing Address - Phone:901-276-3222
Mailing Address - Fax:901-257-2006
Practice Address - Street 1:1469 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2934
Practice Address - Country:US
Practice Address - Phone:901-276-3222
Practice Address - Fax:901-257-2006
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3839367Medicare ID - Type Unspecified
TNG39176Medicare UPIN