Provider Demographics
NPI:1235534280
Name:ROSS, ADRIANNA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 ROUTE 121
Mailing Address - Street 2:APT B
Mailing Address - City:WINDHAM
Mailing Address - State:VT
Mailing Address - Zip Code:05359-9632
Mailing Address - Country:US
Mailing Address - Phone:802-875-1779
Mailing Address - Fax:
Practice Address - Street 1:1104 ROUTE 121
Practice Address - Street 2:APT B
Practice Address - City:WINDHAM
Practice Address - State:VT
Practice Address - Zip Code:05359-9632
Practice Address - Country:US
Practice Address - Phone:802-875-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0107840176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife