Provider Demographics
NPI:1043359490
Name:RODRIGUEZ-ROSS, LINDA ANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANNE
Last Name:RODRIGUEZ-ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 LUCILE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4918
Mailing Address - Country:US
Mailing Address - Phone:940-781-8736
Mailing Address - Fax:940-322-4814
Practice Address - Street 1:2007 LUCILE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4918
Practice Address - Country:US
Practice Address - Phone:940-781-8736
Practice Address - Fax:940-322-4814
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631626171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173596101OtherTEXAS TPI NUMBER