Healthcare Provider Details

I. General information

NPI: 1366995706
Provider Name (Legal Business Name): PAULA ROSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E PINE ST
SHERIDAN AR
72150-2551
US

IV. Provider business mailing address

305 E PINE ST
SHERIDAN AR
72150-2551
US

V. Phone/Fax

Practice location:
  • Phone: 747-227-4641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR053537
License Number StateAR

VIII. Authorized Official

Name: MS. PAULA J ROSS
Title or Position: LACTATION CONSULTANT
Credential: RN, IBCLC
Phone: 747-227-4641