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:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 N BROTHER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2760
Mailing Address - Country:US
Mailing Address - Phone:901-255-5221
Mailing Address - Fax:901-373-4511
Practice Address - Street 1:681 S WHITE STATION RD STE 111
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4563
Practice Address - Country:US
Practice Address - Phone:901-276-3222
Practice Address - Fax:901-276-1398
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3839367Medicare ID - Type Unspecified
TNG39176Medicare UPIN