MEDICARE: MS. JOAN L ROSS RN, BSN, MSN

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	163W00000X	Registered Nurse	280195-0	NY

General Provider Information

NPI Number	:	1972576916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN L ROSS RN, BSN, MSN

Provider Business Mailing Address
First Line	:	12664 CLAREMONT CIR
Second Line	:
City	:	DEL VALLE
State	:	TX
Zip	:	78617-5248
Country	:	US
Telephone Number	:	512-993-8687
Fax Number	:

Provider Business Practice Location Address
First Line	:	12664 CLAREMONT CIR
Second Line	:
City	:	DEL VALLE
State	:	TX
Zip	:	78617-5248
Country	:	US
Telephone Number	:	512-993-8687
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/15/2016

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