Provider Demographics
NPI:1033758826
Name:ROSS, NATHAN DAVID (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAVID
Last Name:ROSS
Suffix:
Gender:M
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MOUNTAINEER VLG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9450
Mailing Address - Country:US
Mailing Address - Phone:304-374-7832
Mailing Address - Fax:
Practice Address - Street 1:956 MAPLE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2813
Practice Address - Country:US
Practice Address - Phone:304-291-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily