Healthcare Provider Details

I. General information

NPI: 1083520092
Provider Name (Legal Business Name): EVANI SANTOS ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 HIGGINS RD
PLATTE CITY MO
64079-9232
US

IV. Provider business mailing address

11112 N HIGHWAY
PLATTE CITY MO
64079-8226
US

V. Phone/Fax

Practice location:
  • Phone: 913-651-9159
  • Fax:
Mailing address:
  • Phone: 913-530-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: