Provider Demographics
NPI:1093307340
Name:ROSS, DESTINEY MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DESTINEY
Middle Name:MARIE
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 1:73 SEMINOLE PKWY LOWR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1812
Mailing Address - Country:US
Mailing Address - Phone:716-517-5567
Mailing Address - Fax:
Practice Address - Street 1:73 SEMINOLE PKWY LOWR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1812
Practice Address - Country:US
Practice Address - Phone:716-517-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332924164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse