Healthcare Provider Details

I. General information

NPI: 1790755114
Provider Name (Legal Business Name): DONNA M ROSS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14519 DETROIT AVE
LAKEWOOD OH
44107-4316
US

IV. Provider business mailing address

14519 DETROIT AVE
LAKEWOOD OH
44107-4316
US

V. Phone/Fax

Practice location:
  • Phone: 216-529-8500
  • Fax: 216-528-8505
Mailing address:
  • Phone: 216-529-8500
  • Fax: 216-528-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberNS-08553
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: