MEDICARE: MS. MONIQUE JEAN ROUSE LPN

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	164W00000X	Licensed Practical Nurse	31282331	WI

General Provider Information

NPI Number	:	1841556933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONIQUE JEAN ROUSE LPN

Provider Business Mailing Address
First Line	:	PO BOX 90253
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-0253
Country	:	US
Telephone Number	:	414-313-4872
Fax Number	:

Provider Business Practice Location Address
First Line	:	8603 W GREEN BROOK DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2126
Country	:	US
Telephone Number	:	414-313-4872
Fax Number	:

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

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	04/03/2012

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