Provider Demographics
NPI:1093443665
Name:ROSS, TAMORA DAWN
Entity Type:Individual
Prefix:MRS
First Name:TAMORA
Middle Name:DAWN
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ANNEX DR
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-4026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 ARNOLD DRIVE
Practice Address - Street 2:
Practice Address - City:GLENGARY
Practice Address - State:WV
Practice Address - Zip Code:25421
Practice Address - Country:US
Practice Address - Phone:304-270-7514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant