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General NPI Number Information
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NPI Number | 1750355178
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Entity Type | Individual
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Provider Name | THERESA ANN ROSS
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Gender | Female
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11050 MOUNT BELVEDERE BLVD USA MEDDAC ATTN CREDENTIALS
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City | FORT DRUM
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State | NY
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Zip | 13602-5438
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Country | US
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Telephone | 315-772-4025
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Fax | 315-772-9498
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Provider Business Mailing Address
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Address Line | 12301 COLBY LAKE RD PO BOX 568
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City | LAINGSBURG
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State | MI
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Zip | 48848-9313
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Country | US
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Telephone | 517-290-3875
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 4704123246
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License Number State | MI
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