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NPI Code Detail

MEDICARE: MRS. GWYNETTA HURST ROSSI FNP

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
1363L00000XNurse Practitioner678786TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18Y0141OTHERTXBLUE CROSS BLUE SHIELD
28Y0140OTHERTXBLUE 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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Directions to “ MRS. GWYNETTA HURST ROSSI FNP” Practice Location

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