MEDICARE: CAMILE ROSS GNP

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	363LG0600X	Gerontology Nurse Practitioner	605118	TX

General Provider Information

NPI Number	:	1427213560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILE ROSS GNP

Provider Business Mailing Address
First Line	:	3704 HIGHLAND VIEW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4035
Country	:	US
Telephone Number	:	512-657-1729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 W NEW HOPE DR
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-6018
Country	:	US
Telephone Number	:	512-657-1729
Fax Number	:

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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