MEDICARE: REGINA ROSS

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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1558160838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA ROSS

Provider Business Mailing Address
First Line	:	9744 MOCKINGBIRD DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-2013
Country	:	US
Telephone Number	:	402-800-3787
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 FOWLER AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-2328
Country	:	US
Telephone Number	:	402-201-9271
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/11/2025

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Directions to “ REGINA ROSS ” Practice Location

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