Provider Demographics
NPI:1073766952
Name:ROSS, NANCY A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3309
Mailing Address - Country:US
Mailing Address - Phone:716-286-0788
Mailing Address - Fax:716-286-7018
Practice Address - Street 1:4455 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-3309
Practice Address - Country:US
Practice Address - Phone:716-286-0788
Practice Address - Fax:716-286-7018
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332234-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily