Provider Demographics
NPI:1891471165
Name:ROUSSEAU, JUDITH (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2915
Mailing Address - Country:US
Mailing Address - Phone:774-409-5078
Mailing Address - Fax:
Practice Address - Street 1:11 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2915
Practice Address - Country:US
Practice Address - Phone:774-409-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2329051163WS0200X, 163WG0000X, 163WA0400X, 163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health