Provider Demographics
NPI:1770846511
Name:DENNIS, CATHY ROUSSELL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ROUSSELL
Last Name:DENNIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5718
Mailing Address - Country:US
Mailing Address - Phone:985-536-2128
Mailing Address - Fax:985-536-8997
Practice Address - Street 1:473 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5509
Practice Address - Country:US
Practice Address - Phone:985-532-2128
Practice Address - Fax:985-536-8997
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68511163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health