Provider Demographics
NPI:1033251863
Name:ROSS, LILLIAN M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22140 EUCLID AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1614
Mailing Address - Country:US
Mailing Address - Phone:216-692-3408
Mailing Address - Fax:
Practice Address - Street 1:22140 EUCLID AVE APT 502
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1614
Practice Address - Country:US
Practice Address - Phone:216-692-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-125381-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse