Healthcare Provider Details

I. General information

NPI: 1679911143
Provider Name (Legal Business Name): SANDRA V ROSS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5047 GERRARDSTOWN RD STE 2A
INWOOD WV
25428-3951
US

IV. Provider business mailing address

181 SENECA ST
HORNELL NY
14843-1335
US

V. Phone/Fax

Practice location:
  • Phone: 304-229-2273
  • Fax: 304-821-1450
Mailing address:
  • Phone: 607-324-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95324
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95324
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: