Provider Demographics
NPI:1225069412
Name:ROSS, ROSE M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:M
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 1:1910 E MILLER RD
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:FAIRVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48621-8731
Mailing Address - Country:US
Mailing Address - Phone:989-848-5484
Mailing Address - Fax:989-848-7139
Practice Address - Street 1:1910 E MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MI
Practice Address - Zip Code:48621-8731
Practice Address - Country:US
Practice Address - Phone:989-848-5484
Practice Address - Fax:989-848-7139
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704091848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4747166Medicaid
MI5008773530OtherBCBS
MI4747175Medicaid
MI700G210140OtherBC GROUP PIN
MI700G210140OtherBC GROUP PIN
MIOP19270 002Medicare PIN
MI4747166Medicaid