Provider Demographics
NPI:1114559333
Name:ROSS, SONDRA (RN)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name: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 1:16546 SIEGEL DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1663
Mailing Address - Country:US
Mailing Address - Phone:779-233-1174
Mailing Address - Fax:
Practice Address - Street 1:16546 SIEGEL DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1663
Practice Address - Country:US
Practice Address - Phone:779-233-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04133286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse