Provider Demographics
NPI:1104715135
Name:ROSS, SANDRA LYNN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 E MOUNT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LOOKOUT
Mailing Address - State:WV
Mailing Address - Zip Code:26678-9278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:364 E MOUNT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:MOUNT LOOKOUT
Practice Address - State:WV
Practice Address - Zip Code:26678-9278
Practice Address - Country:US
Practice Address - Phone:304-651-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide