Healthcare Provider Details

I. General information

NPI: 1932508330
Provider Name (Legal Business Name): LAUREN ROSS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 2ND AVE
DETROIT MI
48202-2739
US

IV. Provider business mailing address

7430 2ND AVE SUITE 210
BIRMINGHAM MI
48009-2084
US

V. Phone/Fax

Practice location:
  • Phone: 313-748-4085
  • Fax:
Mailing address:
  • Phone: 313-748-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704261663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: