Provider Demographics
NPI:1780013011
Name:ROUSSEAU, JULIE MARIE (CNM, RN)
Entity Type:Individual
Prefix:PROF
First Name:JULIE
Middle Name:MARIE
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA IRVINE
Mailing Address - Street 2:252F BERK HALL
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-3959
Mailing Address - Country:US
Mailing Address - Phone:949-824-4836
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA IRVINE
Practice Address - Street 2:252F BERK HALL
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-3959
Practice Address - Country:US
Practice Address - Phone:949-824-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1966367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife