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General NPI Number Information
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NPI Number | 1104862382
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Entity Type | Individual
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Provider Name | JEAN D. ROSS NP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 2516 E DUPONT RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-1608
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Country | US
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Telephone | 260-434-6076
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Fax | 260-489-0833
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Provider Business Mailing Address
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Address Line | 6920 POINTE INVERNESS WAY STE 200 MEDPARTNERS, ATTN: BARB COPELAND
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City | FORT WAYNE
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State | IN
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Zip | 46804-7934
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Country | US
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Telephone | 260-479-3514
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Fax | 260-479-3520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71000818A
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License Number State | IN
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