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General NPI Number Information
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NPI Number | 1316739121
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH ROUSSELL
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 22464 HIGHWAY 435
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City | ABITA SPRINGS
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State | LA
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Zip | 70420-2206
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Country | US
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Telephone | 985-893-7835
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Fax |
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Provider Business Mailing Address
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Address Line | 4904 TARTAN DR
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City | METAIRIE
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State | LA
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Zip | 70003-2641
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Country | US
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Telephone | 985-801-9183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7683
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License Number State | LA
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