Provider Demographics
NPI:1235682709
Name:ROSS, CARY LEE (RN MSN)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:LEE
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:CARY
Other - Middle Name:LEE
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1107 S BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2429
Mailing Address - Country:US
Mailing Address - Phone:314-402-2201
Mailing Address - Fax:
Practice Address - Street 1:1107 S BENTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2429
Practice Address - Country:US
Practice Address - Phone:314-402-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017895163WN0002X
MO2016030696363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care