Provider Demographics
NPI:1982668653
Name:ROUSSEAU, LINDA (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILLOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9091
Mailing Address - Country:US
Mailing Address - Phone:207-772-1022
Mailing Address - Fax:207-772-2022
Practice Address - Street 1:11 WILLOWDALE RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9091
Practice Address - Country:US
Practice Address - Phone:207-772-1022
Practice Address - Fax:207-772-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER020870363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEQ07049Medicare UPIN
MENP4400Medicare ID - Type Unspecified