Provider Demographics
NPI:1003815523
Name:ROSS, LARIANN S (APRN-BC)
Entity Type:Individual
Prefix:
First Name:LARIANN
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:DMC/IMC
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-5706
Mailing Address - Fax:912-435-5569
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:DMC/IMC
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-5706
Practice Address - Fax:912-435-5569
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR100155363LF0000X
TN079281363LF0000X
FL2778862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily