Healthcare Provider Details

I. General information

NPI: 1003528464
Provider Name (Legal Business Name): ERIKA ROUSSEAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA ROUSSEAU RN

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 SHELLBARK DR
MCDONOUGH GA
30252-1625
US

IV. Provider business mailing address

263 SHELLBARK DR
MCDONOUGH GA
30252-1625
US

V. Phone/Fax

Practice location:
  • Phone: 561-201-4678
  • Fax:
Mailing address:
  • Phone: 561-201-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9412623
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberPHCP011679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: