Healthcare Provider Details

I. General information

NPI: 1992144208
Provider Name (Legal Business Name): ROSS PUTERBAUGH ANP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NE 139TH ST SUITE 460
VANCOUVER WA
98686-2309
US

IV. Provider business mailing address

2101 NE 139TH ST SUITE 460
VANCOUVER WA
98686-2309
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-2727
  • Fax: 360-487-4849
Mailing address:
  • Phone: 360-487-2727
  • Fax: 360-487-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP.AP.60378735-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: