Healthcare Provider Details

I. General information

NPI: 1326228966
Provider Name (Legal Business Name): KEVIN ROSS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 WASHBURN ST
ERIE CO
80516-6979
US

IV. Provider business mailing address

1426 WASHBURN ST
ERIE CO
80516-6979
US

V. Phone/Fax

Practice location:
  • Phone: 720-771-8806
  • Fax: 866-491-5401
Mailing address:
  • Phone: 720-771-8806
  • Fax: 866-491-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172872
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number172872
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number172872
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number172872
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number172872
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: