Kevin William Rousseau

Individual provider Active NPI General Practice Registered Nurse · Millis, MA

NPI 1164010682 · NPPES record last updated Jan 10, 2021

Key facts

NPI
1164010682
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Registered Nurse 163WG0000X
License
146044 (MA)
Practice address
69 Pleasant St
Millis, MA 02054-1477
Phone
(774) 249-8782
NPI assigned
Jan 10, 2021
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
146044MAMDGeneral Practice Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 146044 MA Yes

Addresses

Primary practice location

69 Pleasant St
Millis, MA 02054-1477

Mailing address

69 Pleasant St
Millis, MA 02054-1477
Phone (774) 249-8782

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL Millis
CONNECT URL Millis Other

Other providers in Millis, MA

All providers in Millis, MA · General Practice Registered Nurse in Massachusetts

Sources for this page

Verify at the official NPI Registry.