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General NPI Number Information
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NPI Number | 1356353791
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Entity Type | Individual
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Provider Name | NATHAN ROUSSE C.N.P.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 217 S MADISON STREET
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2320
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Country | US
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Telephone | 231-922-9270
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Fax | 231-922-9271
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Provider Business Mailing Address
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Address Line | 1105 SIXTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2345
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Country | US
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Telephone | 231-935-5000
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Fax | 231-935-6081
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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 | 364SX0200X
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Taxonomy Name | Oncology Clinical Nurse Specialist
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License Number | 4704225508
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704225508
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License Number State | MI
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