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General NPI Number Information
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NPI Number | 1508296377
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Entity Type | Individual
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Provider Name | TERI ROSS
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Gender | Female
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 54 CHESTNUT ST
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City | PORTLAND
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State | ME
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Zip | 04101-3038
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Country | US
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Telephone | 207-370-9166
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4573
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City | PORTLAND
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State | ME
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Zip | 04112-4573
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Country | US
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Telephone | 207-408-1178
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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 | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State | FL
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