Healthcare Provider Details

I. General information

NPI: 1396472031
Provider Name (Legal Business Name): KATELYN MARIE ROUSSEL DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7365
US

IV. Provider business mailing address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7365
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-3455
  • Fax: 563-584-3451
Mailing address:
  • Phone: 563-584-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA170418
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: