Healthcare Provider Details

I. General information

NPI: 1598877367
Provider Name (Legal Business Name): ELIZABETH MARY ROSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

3824 NE 68TH AVE
PORTLAND OR
97213-5119
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-3742
  • Fax:
Mailing address:
  • Phone: 503-571-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number000028897N7
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30000672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: