MEDICARE: MRS. GWYNETTA HURST ROSSI FNP

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	363L00000X	Nurse Practitioner	678786	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y0141	OTHER	TX	BLUE CROSS BLUE SHIELD
2	8Y0140	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972609410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GWYNETTA HURST ROSSI FNP

Provider Business Mailing Address
First Line	:	3607 MUSTANG LN
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3577
Country	:	US
Telephone Number	:	713-824-6568
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 W HOLCOMBE ST.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025
Country	:	US
Telephone Number	:	302-674-4700
Fax Number	:	302-744-7181

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	12/26/2012

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