MEDICARE: EMILY KATE ROUSSE RNFA, RNAS-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	200441371RN	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200441371RN	OTHER	OR	OREGON NURSING LICENSE
2	1765478	OTHER		CNOR
3	R80383	OTHER		RNAS-C

General Provider Information

NPI Number	:	1144926973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KATE ROUSSE RNFA, RNAS-C

Provider Business Mailing Address
First Line	:	33808 SLAVENS RD
Second Line	:
City	:	WARREN
State	:	OR
Zip	:	97053-9517
Country	:	US
Telephone Number	:	503-522-7388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 NW 18TH AVE STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2516
Country	:	US
Telephone Number	:	503-542-4888
Fax Number	:	503-542-2813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	12/31/2023

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