MEDICARE: DR. NINA SUZANNE ROSS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPAT 2799	NM

General Provider Information

NPI Number	:	1265606917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINA SUZANNE ROSS PHD

Provider Business Mailing Address
First Line	:	1934 HANO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3307
Country	:	US
Telephone Number	:	505-982-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 HANO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3307
Country	:	US
Telephone Number	:	505-982-5252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/14/2008

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