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General NPI Number Information
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NPI Number | 1730040049
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Entity Type | Individual
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Provider Name | JESSICA L ROSS
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Gender | Female
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 3584 FAIRLANES AVE SW STE 2
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City | GRANDVILLE
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State | MI
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Zip | 49418-1583
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Country | US
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Telephone | 616-797-2124
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Fax |
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Provider Business Mailing Address
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Address Line | 532 S UNION ST
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City | SPARTA
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State | MI
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Zip | 49345-1506
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Country | US
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Telephone | 616-302-4295
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Fax | 616-302-4295
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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 | 4703125941
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License Number State | MI
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