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General NPI Number Information
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NPI Number | 1205147253
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Entity Type | Individual
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Provider Name | DEBRA LYNN ROSS L.P.N.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 4124 ALBY ST
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City | ALTON
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State | IL
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Zip | 62002-4478
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Country | US
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Telephone | 618-466-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 3213 MORKEL DR
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City | GODFREY
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State | IL
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Zip | 62035-1842
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Country | US
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Telephone | 618-466-3173
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043.076178
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License Number State | IL
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