Basic Information
| Provider Information | |||||||||
| NPI: | 1801096920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROUSSEAU | ||||||||
| FirstName: | JEANNETTE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LDN RD CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 298 CINDY LOU PLACE | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856260128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1202 S TYLER STREET | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858984000 | ||||||||
| FaxNumber: | 9858983778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 07/18/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 348 | LA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.